Pityriasis rosea as a cutaneous manifestation of COVID‐19 infection

Dear Editor

Cutaneous manifestation has been reported in 0.2% of patients infected by COVID‐19 in China ¹ and 18 out of 88 patients from Italy. ² The most commonly reported features are exanthematous rash, urticaria, chickenpox‐like vesicles, petechiae and acute haemorrhagic oedema of infancy. ³ , ⁴ , ⁵

Herein, we report one case of pityriasis rosea in a patient infected with COVID‐19.

A 27‐year‐old man with no previous medical history presented initially with low‐grade fever, fatigue, gastroenteritis and anorexia. Three days later, an erythematous and scaly annular plaque appeared on the left forearm, and several days later, generalized papular and plaque‐type lesions occurred all over the trunk and upper extremities in a shape that resembles drooping pine‐tree branches (Fig. 1). Lesions continued to disseminate for 5 days and became pruritic. A chest CT showed patchy ground‐glass infiltration at the peripheral and base of both lungs consistent with the COVID‐19 infection. Laboratory investigation revealed no specific abnormality, and blood oxygen saturation was normal. Patient had history of long‐term intake of sertraline and propranolol without any change in the treatment regime during the last months. Family history of patient uncovered confirmed COVID‐19 infection in mother 50 days and father 40 days earlier with fever, dyspnoea, myalgia and ground‐glass features in the chest CT. As patient’s general condition and oxygen saturation were normal, patient was followed up out‐patiently with topical corticosteroid and anti‐histamine (cetirizine) for pruritic lesions and acetaminophen for fever, if indicated.

Figure 1.

Generalized erythematous papules and plaques on the trunk and upper extremities along the cleavage line (a, b). The typical presentation of herald patch with trailing scale (c).

The described case here seems reminiscent of pityriasis rosea with typical presentation of herald patch with collaret of trailing scale that followed with smaller disseminated lesion developing along the lines of cleavage. Pityriasis rosea has been usually associated with reactivation of herpesvirus 6 and 7, but other viral aetiology, vaccination and drugs have also been implicated as the cause of this reaction. ⁶ Our case could be a cutaneous manifestation of COVID‐19 viral infection and help dermatologist to get familiar with skin rash due to this new viral infection.