Mucocutaneous manifestations of COVID-19: a prospective study of 100 patients in Iran

Cutaneous manifestations of coronavirus disease 2019 (COVID-19) are not uncommon and can be the presenting sign of the disease. We aimed to investigate the cutaneous manifestations in COVID-19 patients. This cross-sectional study was performed on COVID-19 patients referred to Shohada-e Tajrish and Modarres hospitals, Tehran, Iran, from January 1, 2021 to March 31, 2021. Patients with cutaneous lesions were included in the study; if needed, patients were visited in person, and a biopsy was taken. Of the 100 COVID-19 patients in this study, with a mean age of 45.53 ± 17.75 years, 37 (37%) were males. The most common cutaneous manifestation was urticaria (21%), followed by maculopapular eruptions (17%), petechiae/purpura (15%), pityriasis rosea-like lesions (15%), erythema multiforme (7%), pernio (6%), Vesicles/pseudovesicles/bullae (5%), and others (24%). Most lesions were erythematosus (87.63%). Legs (40%) were most frequently involved. The most common accompanying symptom was pruritus (52%), followed by burning sensations (18%) and pain (7%). Six patients had mucosal lesions; these lesions were the only mucocutaneous manifestations in three of them. Skin biopsies were taken from 11 patients, revealing epidermal changesin 10 (90.9%), dermal changes in 7 (63.6%), mucin deposition in 1 (9.1%), perivascular lymphocyte infiltration in 10 (90.9%), and neutrophil infiltration in 1 (9.1%). The frequency of skin manifestations was relatively high in this study, with urticaria as the most common cutaneous presentation of COVID-19. Special attention must be paid to the cutaneous lesions of COVID-19.