Cutaneous manifestations in COVID‐19: familial cluster of urticarial rash

Coronavirus disease (COVID‐19) is a new infectious disease that is rapidly spreading across the world. Many clinical manifestations of the virus have been described, and new symptoms are emerging, but only a few cases of skin manifestation have been described since the pandemic was announced by the World Health Organization in March.¹, ²

Common clinical features of COVID‐19 reported include fever, cough, myalgia, fatigue, headache, shortness of breath and diarrhoea.¹

Some reports have suggested that skin manifestations are present in up to 20.4% of patients with COVID‐19, and reports suggest a wide range of skin conditions being related to the virus, including widespread urticaria, morbilliform rash, erythematous rash, chickenpox‐like vesicles, purpuric rash, dusky acrocyanosis, dry gangrene, petechiae rash coexisting with thrombocytopenia, transient livedo reticularis and red papules on fingers resembling chilblains.²–⁵ Unfortunately, some of these reports do not have clinical pictures to show the relation between COVID‐19 and the skin manifestations.

We report a family of five members living in the city of Monterrey, Mexico who tested positive for COVID‐19, as a result of one of the members becoming infected during a trip to New York in February 2020. All five patients had anosmia, ageusia, chills and dizziness, and two of them had skin manifestations associated with COVID‐19.

Patient 1 was a 50‐year‐old woman, and Patient 2 was a 20‐year‐old woman, who was the daughter of Patient 1. Both patients had a bilateral disseminated rash on the shoulders, elbows, knees and buttocks, characterized by erythematous annular and irregular weals on the skin that appeared suddenly and disappeared within < 24 h (Fig. 1). The rash appeared after the cough and fever appeared. Neither patient had any history of similar lesions, and no trigger factors other than the viral context were identified. No other clinical or laboratory examinations were positive.

Figure 1.

Erythematous annular and irregular weals in two patients with COVID‐19 infection: (a,b) Patient 1, a 50‐year‐old woman; (c,d) Patient 2, a 20‐year‐old woman, who was the daughter of Patient 1.

A diagnosis of urticaria associated with COVID‐19 was made. Both patients were treated with antihistamines and moisturizers, and 48 h after treatment was started the urticaria resolved.

Although urticarial rash is the most common skin manifestation described in COVID‐19 infection, cases can be classified into two groups: those related to the virus and those associated with complications and management.⁵

Further studies are required to elucidate the skin involvement in COVID‐19. Histopathology of active exanthemas may be helpful in understanding the skin manifestations of COVID‐19 infection.