Atypical maculopapular rash as the initial sign of COVID-19: A case report from a COVID hospital

Abstract

Maculopapular rash mainly distributed over the trunk, is reported as the most common cutaneous manifestation in COVID-19 patients. The palms, soles, and face are usually spared. The rash is associated with itching in 56% of patients and is observed along with COVID-19 symptoms. Maculopapular rash is considered as a feature of severe COVID-19 and the lesions usually resolve in 10 days. We report a COVID-19 patient whose initial manifestation was an atypical maculopapular rash with urticarial wheals and erythema multiforme-like lesions. The patient denied drug intake before the onset of skin lesions. The rash was distributed over the face, palms, and soles in addition to the trunk and limbs. The patient had only mild symptoms of COVID-19. The rash lasted for 3 weeks and resolved with post-inflammatory hyperpigmentation and peeling of the skin of the fingertips. We report this case to highlight the possibility of skin rash being the initial sign of COVID-19.