Skin Manifestations Among Patients Admitted with COVID-19: A Cross-Sectional Study at a University-Based Tertiary Hospital in Jordan

Diala M Alshiyab,1 Firas A Al-qarqaz,1 Enas Alhaje,1 Jihane A Mayou,1 Saja Jaradat,1 Ansam Asaad,1 Jihan M Muhaidat,1 Yousef Khader,2 Safa’ M Alsheyab,3 Ashraf O Oweis,4 Basheer Y Khassawneh,4 Suleiman M Momany,4 Shaher M Samrah,4 Musa Al-Ali4 1Department of Dermatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; 2Department of Public Health, Community Medicine, Jordan University of Science and Technology, Irbid, Jordan; 3Department of Mathematics and Statistics, Jordan University of Science and Technology, Irbid, Jordan; 4Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, JordanCorrespondence: Diala M Alshiyab, Department of Dermatology, Faculty of Medicine, Jordan University of Science and Technology, P.O.BOX 3030, Irbid, 22110, Jordan, Tel +962798608037, Email dmalshiyab@just.edu.joBackground: COVID-19 pandemic hit the entire world with severe health and economic consequences. Although the infection primarily affected the respiratory system, it was soon recognized that COVID-19 has a multi-systemic component with various manifestations including cutaneous involvement.Objective: The main objective of this study is to assess the incidence and patterns of cutaneous manifestations among moderate-to-severe COVID-19 patients who required hospitalization and whether there was a prognostic indication for cutaneous involvement and the outcome in terms of recovery or death.Methods: This is a cross-sectional observational study that included inpatients who were diagnosed with a moderate or severe COVID-19 infection. The demographic and clinical data of patients were assessed including age, sex, smoking, and comorbidities. All patients were examined clinically for the presence of skin manifestations. Patients were followed for the outcome of COVID-19 infection.Results: A total of 821 patients (356 females and 465 males) aged 4– 95 years were included. More than half of patients (54.6%) aged > 60 years. A total of 678 patients (82.6%) had at least one comorbid condition, mostly hypertension and diabetes mellitus. Sixty-two patients (7.55%) developed rashes; 5.24% cutaneous and 2.31% oral. The rashes were then grouped into five major types: group A, Exanthema: morbilliform, papulovesicular, varicella-like. Group B, Vascular: Chilblain-like lesions, purpuric/petechial, livedoid lesions. Group C, Reactive erythemas: Urticaria, Erythema multiforme. Group D, other skin rashes including flare-up of pre-existing disease, and O for oral involvement. Most patients (70%) developed rash after admission. The most frequent skin rashes were reactive erythema (23.3%), followed by vascular (20.9%), exanthema (16.3%), and other rashes with flare-ups of pre-existing diseases (39.5%). Smoking and loss of taste were associated with the appearance of various skin rashes. However, no prognostic implications were found between cutaneous manifestations and outcome.Conclusion: COVID-19 infection may present with various skin manifestations including worsening of pre-existing skin diseases.Keywords: COVID-19, cutaneous manifestations, vitiligo-like hypopigmentation, pigmented purpuric dermatosis