Dermatological manifestations among patients with COVID-19: The Sri Lankan experience

Background: Patients diagnosed with COVID-19 demonstrate a wide spectrum of cutaneous manifestations, some of which are at a high prevalence. These manifestations, of which some are unique, have been considered to occur due to COVID-19 infection and the associated inflammatory response. Furthermore, there are reports on exacerbation of previously diagnosed dermatoses and cutaneous side effects of medications and vaccines administered.
Methodology: The first phase of the study included a descriptive cross-sectional study conducted at the National Hospital of Sri Lanka (NHSL) among PCR-positive COVID patients to identify their skin conditions. Secondly, to ascertain an overall understanding of the country’s situation, a comprehensive questionnaire was circulated among the members of the Sri Lanka College of Dermatologists, to obtain information on the patients they have encountered.
Results: Out of the patients at NHSL only 1.7% (n=8) had developed associated skin manifestations. Two (0.4%) developed novel conditions: thrombophlebitis and a maculopapular exanthem. Six (1.3%) patients had exacerbation of pre-existing conditions including eczema, psoriasis and discoid lupus erythematosus. The dermatologists revealed a wide variety of manifestations with the majority experiencing an exacerbation of pre-existing conditions and a few developing novel lesions including COVID-toes and Kawasaki-like diseases in children which are considered specific for COVID-19.
Conclusions: The study demonstrates a range of COVID-19-associated dermatoses. These can present before or with other COVID-19 symptoms. Further, studies are necessary to precisely determine the timing and pathophysiology of different manifestations. Dermatological findings are important and should prompt the early involvement of dermatologists as appropriate.