Firouzabadi FD, Firouzabadi MD, Ghalehbaghi B, Jahandideh H, et al. Pruritic Eruptions as the Presenting Symptoms of COVID-19. Ann Pediatr Child Health 2020; 8(6): 1195.

The coronavirus disease 2019 (COVID-19), pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), infection, is a constantly evolving condition with new symptoms and manifestations. Common symptoms of COVID-19 include fever, cough, weakness, and dyspnea and the less frequent symptoms include anorexia, diarrhea, abdominal pain, dizziness, headache, fatigue, arthralgia, rhinorrhea, sneezing, myalgia, vomiting, facial pain and fullness, otalgia, olfactory dysfunction, unilateral facial palsy, and vertigo [1-4]. The dermatologic manifestations of COVID-19 remains largely elusive. Preliminary reports have described a wide spectrum of dermatologic findings associated with COVID-19, such as viral exanthems, chilblain-like acral lesions, livedo reticularis, urticaria, petechial, and vesicular rashes [5]. To help raise awareness of cutaneous manifestations of COVID-19, we herein report four COVID-19 patients (based on reverse transcription polymerase chain reaction [RT-PCR] for SARS-CoV-2 infection), in different age categories without remarkable past medical history of allergy or skin disease, who presented with various pruritic skin eruptions, including discrete erythematous plaques, papular rash, urticaria, and eczema-like lesions (Figure 1). Patient characteristics, laboratory results, and outcomes are summarized in Table 1. The patients were managed conservatively with hydroxyzine without antiviral therapy, and followed for two weeks to evaluate the disease progression. None of the patients experienced fever, cough, or dyspnea throughout the clinical course. Vital signs and physical examinations were normal through the end of the follow-up, and all patients completely recovered without any complications. Retested RT-PCR for COVID-19 was negative after two weeks in all four patients. Extending the previous observations, our report indicates that pruritic eruptions could be the initial presenting symptoms of COVID-19 patients. During the COVID-19 pandemic, physicians should stay vigilant when approaching individuals with unexplained dermatologic manifestations who are at high risk or have a recent contact history of COVID-19. Early recognition of dermatologic manifestations may facilitate timely diagnosis and management of COVID-19.

Table 1: Patient characteristics, laboratory results, and outcomes of patients.

1. Bagheri SH, Asghari A, Farhadi M, Shamshiri AR, Kabir A, Kamrava SK, et al. Coincidence of COVID-19 epidemic and olfactory dysfunction outbreak in Iran. Med J Islamic Republic Iran. 2020; 34: 446-452.

2. Dehghani Firouzabadi M, Dehghani Firouzabadi F, Goudarzi S, Jahandideh H, Roomiani M. Has the chief complaint of patients with COVID-19 disease changed over time? Med Hypotheses. 2020: 109974.

3. Dehghani Firouzabadi F, Dehghani Firouzabadi M, Ghalehbaghi B, Jahandideh H, Roomiani MSG. Have the symptoms of patients with COVID-19 changed over time during hospitalization? Med Hypotheses. 2020; In Press.

4. Guan Wj, Ni Zy, Hu Y, Liang Wh, Ou Cq, He Jx, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. New England J Med. 2020.

5. Jia JL, Kamceva M, Rao SA, Linos E. Cutaneous manifestations of COVID-19: A preliminary review. J Am Academy Dermatol. 2020; 83: 687-690.