key: cord-0858538-nc3klfcz authors: Avellana Moreno, R.; Estela Villa, L.M.; Avellana Moreno, V.; Estela Villa, C.; Moreno Aparicio, M.A.; Avellana Fontanella, J.A. title: Cutaneous manifestation of COVID‐19 in images: a case report date: 2020-05-19 journal: J Eur Acad Dermatol Venereol DOI: 10.1111/jdv.16531 sha: 87d88bcd663eb0627be6e804d5130779bfc4ab68 doc_id: 858538 cord_uid: nc3klfcz In December 2019, China reported the first group of pneumonia cases associated with a new coronavirus, 2019-SARS-CoV-21 . Currently, the novel coronavirus infection has become a pandemic2 . Significant research efforts are taking place around the world to better understand the transmission dynamics, the spectrum of clinical disease, possible treatment options, and prevention measures. On the sixth day after the onset of symptoms, without a history of taking previous drugs, she presented with a generalized, pruritic morbilliform rash, with a sudden onset, with cephalocaudal progress, associated with low-grade fever and without accompanying respiratory distress. The cutaneous lesions observed are petechial and maculopapular on an erythematous base (Fig. 1) . The distribution of the rash included face, neck, thorax, abdomen, buttocks, extremities, including folds and scalp, respecting the palmo-plantar region and mucosa. Over the following days, the lesions became itchier, while the erythema intensity decreased (Fig. 2) . A scaly reaction occurred on the fourth day after the rash started and disappeared without leaving visible lesions. As the only therapeutic measure, an intravenous dose of corticosteroid and antihistamines was administered. In order to accurately define the cause for the rash, it is important to collect as much information as possible about the episode, chronology and characteristics of the injuries. 4 For this purpose, a comprehensive anamnesis, physical examination and, in this case, due to the high suspicion of COVID-19, a confirmatory RT-PCR test are necessary for the diagnosis. Keeping COVID-19 in the differential diagnosis of a rash is the key because patients may be misdiagnosed by another entity. Joob reports the case of a COVID-19 positive patient who presented petechial rash, being initially misdiagnosed as dengue, delaying the definitive diagnosis. 5 There was apparently no correlation with disease severity. 6 It will also be important to determine whether the injuries are caused by COVID-19, if they are secondary to the use of drugs to treat it and even if they are the consequence of worsening of previous dermatological injuries, either due to emotional stress or by frequent use of disinfectants, hand washing or permanent use of masks. 7 In our case, the patient did not have previous medication intake, nor was she exposed to any disinfectant; therefore, other potential diagnosis was excluded. Based on our findings and review of current literature, we could consider that cutaneous manifestations, although in a low percentage, are present in COVID19 positive patients without being associated with a worse prognosis. We report the first images of cutaneous manifestation of COVID-19. The presence of other symptoms, the epidemiological history and the PCR test will be important to establish the diagnosis and to be able to establish early preventive measures. More studies are needed confirm and better understand how COVID-19 affects the skin. A pneumonia outbreak associated with a new coronavirus of probable bat origin World Health Organization. Coronavirus disease (COVID-19) Situation Dashboard Clinical characteristics of coronavirus disease 2019 in China Viral exanthems: An update on laboratory testing of the adult patient COVID-19 can present with a rash and be mistaken for Dengue Cutaneous manifestations in COVID-19: a first perspective Dermatology staff participate in fight against Covid-19 in China The patient in this manuscript has given written informed consent to the publication of their case details. None reported.