Cutaneous Manifestations in COVID-19 Patients Admitted to Al-Hussein Teaching Hospital in Dhi-Qar Province


  • Hadaf A. AL-Junaiyeh
  • Dhulfiqar A. Kadhim


COVID-19, novel coronavirus, SARS-CoV-2


Background: the cutaneous manifestations of COVID-19 are increasingly reported and they are important clues for early detection of SARS-CoV-2 infection. Objective: To describe the different morphologies of skin and/or mucosal lesions associated with confirmed COVID-19 adult patients who have been admitted to the main quarantine hospital in Dhi-Qar province. Patients and methods: All confirmed COVID-19 patients were examined for mucosal and/or cutaneous lesion, and those who had such manifestations were evaluated and subjected to a detailed history, a complete physical examination and photography for documentation. The patients were classified into five groups according to lesions’ morphology; maculopapular, urticarial, pustular and papulovesicular, vasculitic and miscellaneous groups. Results: Out of 3554 confirmed COVID-19 patients only 157 showed mucocutaneous manifestations, of them116 patients were excluded for many reasons as cutaneous adverse drug reactions (CADR), other infections …etc. The remaining 41 patients who represent (1.15%) were included and classified into; maculopapular (29.26%), urticarial (24.39%), pustular and papulovesicular (17.07%), vasculitic (14.63%) and miscellaneous (14.63%). Conclusions: This study has shown that there are many cutaneous manifestations in COVID-19 disease that may differ from one country to another, while some are constant around the globe, so it is important for any doctor, not just the dermatologists, to recognize and bear these presentations in mind during this pandemic for early detection, better treatment and prevention of SARS-CoV-2 infection, hopefully that one day this pandemic is over by the collaboration of all of us.


- Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382(8):727–33.

- Gupta A, Madhavan MV, Sehgal K, Nair N, Mahajan S, Sehrawat TS, et al. Extrapulmonary manifestations of COVID-19. Nat Med. 2020 Jul;26(7):1017-1032.

- Elmas ÖF, Demirbaş A, Özyurt K, Atasoy M, Türsen Ü. Cutaneous manifestations of COVID‐19: A review of the published literature. Dermatologic therapy. 2020 Jul;33(4):e13696.

- Leng Z, Zhu R, Hou W, Feng Y, Yang Y, Han Q, et al. Transplantation of ACE2-mesenchymal stem cells improves the outcome of patients with COVID-19 pneumonia. Aging and disease. 2020;11(2):216.

- Rahimi H, Tehranchinia Z. A comprehensive review of cutaneous manifestations associated with COVID-19. BioMed research international. 2020 Jul 5;2020.

- Galván Casas C, Catala AC, Carretero Hernández G, et al. Classification of the cutaneous manifestations of COVID‐19: a rapid prospective nationwide consensus study in Spain with 375 cases. British Journal of Dermatology. 2020;183(1):71-7.

- Recalcati S. Cutaneous manifestations in COVID‐19: a first perspective. Journal of the European Academy of Dermatology and Venereology. 2020 Mar 26.

- Mahé A, Birckel E, Krieger S, Merklen C, Bottlaender L. A distinctive skin rash associated with Coronavirus Disease 2019?. Journal of the European Academy of Dermatology and Venereology. 2020 Apr 15; 34:246–247.

- Najarian DJ. Morbilliform exanthem associated with COVID-19. JAAD Case Reports. 2020 Jun;6(6):493.

- Henry D, Ackerman M, Sancelme E, Finon A, Esteve E. Urticarial eruption in COVID‐19 infection. Journal of the European Academy of Dermatology and Venereology. 2020 Apr 15;34:244–5.

- Morey-Olivé M, Espiau M, Mercadal-Hally M, Lera-Carballo E, García-Patos V, et al. Skin manifestations in the context of the current outbreak of coronavirus disease 2019. InAnales De Pediatria .2020;92:374-5.

- van Damme C, Berlingin E, Saussez S, Accaputo O. Acute urticaria with pyrexia as the first manifestations of a COVID-19 infection. Journal of the European Academy of Dermatology and Venereology. 2020;34(7):e300-e301.

- Paolino G, Canti V, Santo Raffaele Mercuri PR, Candiani M, Pasi F. Diffuse cutaneous manifestation in a new mother with COVID‐19 (SARS‐Cov‐2). International Journal of Dermatology. 2020,59(7): 874-5.

- Tammaro AN, Adebanjo GA, Parisella FR, Pezzuto A, Rello J, et al. Cutaneous manifestations in COVID‐19: the experiences of Barcelona and Rome. Journal of the European Academy of Dermatology and Venereology. 2020 Apr 24.

- Pouletty M, Borocco C, Ouldali N, Caseris M, Basmaci R, Lachaume N, et al. Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 mimicking Kawasaki disease (Kawa-COVID-19): a multicentre cohort. Annals of the Rheumatic Diseases. 2020 Jun 11;79: 999–1006.

- Jones VG, Mills M, Suarez D, Hogan CA, Yeh D, Segal JB, et al. COVID-19 and Kawasaki disease: novel virus and novel case. Hospital Pediatrics. 2020 Jun 1;10(6):537-40.

- Almashat SA. Vasculitis in COVID-19: a literature review. J vasc. 2020 May;6(1):1-5.

- Recalcati S, Barbagallo T, Frasin LA, Prestinari F, Cogliardi A, Provero MC, et al. Acral cutaneous lesions in the time of COVID‐19. Journal of the European Academy of Dermatology and Venereology. 2020 Apr 24.

- Dominguez-Santas M, Diaz-Guimaraens B, Fernandez-Nieto D, et al. Minor aphthae associated with SARS-CoV-2 infection. International Journal of Dermatology. 2020 ;59(8):1022-1023.

- Zhang Y, Cao W, Xiao M, Li YJ, Yang Y, Zhao J, et al. Clinical and coagulation characteristics in 7 patients with critical COVID-2019 pneumonia and acro-ischemia. 2020;41(4):302-7.

- Joob B, Wiwanitkit V. COVID-19 can present with a rash and be mistaken for Dengue. Journal of the American Academy of Dermatology. 2020;82(5):e177.

- Hedou M, Carsuzaa F, Chary E, Hainaut E, Cazenave‐Roblot F, Masson Regnault M. Comment on “Cutaneous manifestations in COVID‐19: a first perspective” by Recalcati S. Journal of the European Academy of Dermatology and Venereology. 2020 Apr 21.

- Tosti G, Barisani A, Queirolo P, Pennacchioli E, Villa L, Lodeserto AM, et al. Skin signs resembling vascular acrosyndromes during the COVID‐19 outbreak in Italy. Clinical and Experimental Dermatology. 2020 May 2.

- Alramthan A, Aldaraji W. Two cases of COVID‐19 presenting with a clinical picture resembling chilblains: first report from the Middle East. Clinical and experimental dermatology. 2020 Apr 17.

- Hamming I, Timens W, Bulthuis ML, Lely AT, Navis GV, van Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. The Journal of Pathology: A Journal of the Pathological Society of Great Britain and Ireland. 2004;203(2):631-7.

- Criado PR, Abdalla BM, de Assis IC, de Graaff Mello CV, Caputo GC, Vieira IC. Are the cutaneous manifestations during or due to SARS-CoV-2 infection/COVID-19 frequent or not? Revision of possible pathophysiologic mechanisms. Inflammation Research. 2020 Jun 5:1.