Prevalence and pattern of acute dermatological manifestations of the novel COVID‐19 infection at a COVID‐19 treatment center in Sub‐Saharan Africa

Dear Editor,

The advent of the COVID‐19 infection has led to reports on its cutaneous manifestations. ¹ , ² , ³ These reports have mostly been case reports and cases series, ⁴ , ⁵ with the prevalence ranging from 0.7% to 20.4%. ² , ⁶ , ⁷ , ⁸ Thus far, except for Morocco, there are no documented reports of the prevalence, type of dermatological manifestations nor of the temporal relationship of these lesions with the onset of COVID‐19 infection in Africa nor in Nigeria.

A prospective cross‐sectional study of 161 polymerase chain reaction‐confirmed COVID‐19 adult in‐patients at the Infectious Disease Hospital (IDH), Yaba, Lagos, conducted over a 1‐week period in January 2021 is presented. Ethical approval was provided by the ethics committee of the Lagos State University Teaching Hospital. All patients were clinically examined for any new rash or skin discoloration.

A questionnaire with questions on the duration of COVID‐19 symptoms, new onset rash or skin discoloration, duration of rash and temporal relationship with COVID‐19 symptoms was used. The severity of COVID‐19 was graded based on oxygen saturation (SpO₂) and oxygen therapy. Any patient who had an SpO₂ above 95% on room air and was not being treated with oxygen was regarded as having a moderate severity. Any patient who had an SpO₂ less than 95% on room air and required oxygen therapy was graded as severe. Data were analyzed using SPSS version 20 (SPSS Inc., Chicago). Simple means and frequencies are presented.

The mean age of the patients was 54.4 ± 14.4 years (age range of 16‐88 years). The duration of COVID‐19 ranged from 5 days to 4 weeks with a mean duration of 11.84 (6.11) days. The severity of COVID‐19 was moderate in 57.1% (Table 1). Seven patients had cutaneous manifestation of COVID‐19 giving a prevalence of 4.2%. The cutaneous manifestations were urticaria, morbilliform rash, purpura, blister and a scaly patch. In two patients, the cutaneous manifestation started at the same time with the COVID‐19 symptoms while in five patients, it started after the symptoms.

TABLE 1.

Socio‐demographic and clinical data

Variable	Frequency	Percentage
Gender
Males	88	54.7
Females	73	45.3
Age (y)
<20	1	0.6
20‐29	8	5.0
30‐39	19	11.8
40‐49	20	12.4
50‐59	48	29.8
60‐69	43	26.7
>70	22	13.7
Duration of COVID‐19 symptoms (d)
<7	72	44.7
8‐14	67	41.6
15‐21	13	8.1
22‐28	8	5.0
>28	1	0.6
Severity of COVID‐19 symptoms
Moderate	92	57.1
Severe	69	42.9
Itch
Yes	1	0.6
No	160	99.4
Cutaneous manifestation
Purpura	2	28.6
Scaly patch	1	14.3
Exanthema	1	14.3
Blister	2	28.4
Urticaria	1	14.3
Severity of COVID‐19 in cutaneous manifestation patients
Moderate	2	28.6
Severe	5	71.4
Anatomical site affected
Generalized	2	28.6
Chest	1	14.2
Upper limb	1	14.2
Lower limb	3	43.0

Since the advent of the novel COVID‐19 virus pandemic, diverse cutaneous patterns and diseases have been attributed to COVID‐19. ¹ , ² , ³ , ⁴ , ⁵ The present study documents the prevalence and cutaneous manifestation of COVID‐19 in a cohort of moderate and severe COVID‐19 patients. The prevalence of cutaneous manifestation of COVID‐19 was low in this study. The studies on the prevalence of cutaneous manifestation of COVID‐19 show a varying prevalence from different countries. ² , ⁶ , ⁷ , ⁸ Some of these studies like the present one show a low prevalence ⁶ , ⁷ , ⁸ while in the first study of prevalence from Italy, it is high^{. 2} Prevalence appears to be country and severity dependent.

The cutaneous manifestations of COVID‐19 observed were purpura, blister, scaly patch and exanthema rashes and these skin manifestations were mainly acral. These manifestations are in keeping with what was been documented in case reports and multicenter studies by other authors. ¹ , ² , ³ , ⁵ In the present study, the cutaneous manifestations were more in patients who had severe COVID‐19. Although the number of patients with cutaneous manifestation was few and thus not subjected to statistical analysis of association, the author opines that cutaneous manifestations of COVID‐19 is positively related to the severity of COVID‐19.

In conclusion, COVID‐19 does have diverse cutaneous manifestations but these are however uncommon in dark skin types and dependent on the severity of the COVID‐19.

This study was limited by COVID‐19 being a very infectious disease, thus limiting the number of patients that could safely be studied. Also, this was a single‐center study.

CONFLICT OF INTEREST

The author declares no potential conflict of interest.

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.