Pityriasis rosea Gibert type rash in an asymptomatic patient that tested positive for COVID-19

Dear Editor:

The emergence of the pandemic caused by the new coronavirus (COVID-19) has challenged not only the most organized health systems, but also well-established medical concepts. The high spread of the virus is partly due asymptomatic or oligosymptomatic infected subjects.¹ In this context, new symptoms of COVID-19 are beginning to be described, particularly outside the respiratory domain, mainly otolaryngological² and cutaneous.³ Therefore, knowledge of these manifestations becomes almost compulsory, thus increasing the number of symptoms aimed at achieving a more accurate level of suspicion, in order to increase the detection and early implementation of effective isolation measures in the population.

We report the case of a 19-year-old woman, non-smoker, or drinker, with a personal history of rhinitis and seasonal asthma, atopic dermatitis during childhood and an isolated episode of acute anterior uveitis. She was not undergoing any treatment on a regular basis. Presented with a 7-day history of itchy rash. On examination, an eruption consisting of round and oval erythematous squamous plaques with a peripheral scaling collarette, with distribution on the trunk and upper limbs, leaving the palms, soles, and facial area clean (Fig. 1). There was no evidence of a plaque or herald patch. Close contact at home with 3 relatives with compatible symptoms of mild COVID infection (fever, cough, diarrhoea, and anosmia), however, she had remained asymptomatic, except for the skin condition previously described. Although the patient's symptoms and examination suggested a Pityriasis Rosea Gibert, the epidemic environment of COVID-19 and its diversity of skin manifestations, made us think of a possible skin condition caused by the SARS-CoV-2 virus. We recommended the patient to be isolated for 14 days from the beginning of the symptoms, as established by the Spanish Ministry of Health,¹ in addition to skin moisturizing measures in combination with a topical corticoid in the most pruritic lesions. Twenty days after the start of the symptoms, the presence of SARS-CoV-2 nucleic acids (PCR) was detected in a nasopharyngeal swab. Hematometry, biochemistry, venous blood gas, and coagulation parameters including ferritin, C-reactive protein, lactate dehydrogenase and D-dimer were in normal ranges. The progression of the condition was excellent, with the lesions returning within 2 weeks of the onset and almost completely disappearing after 30 days.

Fig. 1.

The image shows a rash consisting of 0.3 to 1.5 cm in diameter round and oval erythematous scaly plaques with peripheral collarette scaling.

A recent study conducted in Italy by Recalcati S³ revealed that 20.4% of patients hospitalized with COVID-19 developed cutaneous manifestations, some of them at the beginning of the disease and others after hospitalization. Reported manifestations are generalized erythema, hives, livedo reticularis and acro-ischemia (chilblain-like). We consider that this clinical case provides relevant information to doctors, since it shows a patient with exclusively cutaneous Covid-19-related symptoms of unusual appearance.

Funding

This study has not received external funding.