Urticaria is one of the most common skin manifestations reported in patients with coronavirus disease 2019 (COVID-19), with more than half of urticarial rashes occurring before or during classic symptoms of COVID-19, according to research data published in Dermatologic Therapy.
This literature review assessed English-language studies and case reports that focused on urticaria in patients with COVID-19. A total of 30 papers met the inclusion criteria for the review. Among these publications, 202 patients had COVID-19-associated urticaria. Patients were between the ages of 2 months and 84 years, and the majority of patients (64%) were women.
Approximately 55% (n=58) of 105 patients with a determined onset of COVID-19 had rash that preceded or occurred concurrently with classic COVID-19 symptoms. Urticarial rash was either generalized or found on the trunk. In these studies of patients with urticaria and COVID-19, skin rashes were managed with antihistamines as well as systemic and topical steroids. All reported cases responded favorably to these treatments.
A 73-patient study found that approximately 66% of patients with urticaria and COVID-19 had cough, whereas 41% had dyspnea. Another study of 27 patients with urticaria and COVID-19 reported that 59% of patients had cough and 41% had dyspnea. In additional studies consisting of 123 patients, 71% (n=88) had fever during the course of their disease.
In 129 patients, approximately 11% (n=14) required admittance and treatment in the intensive care unit (ICU), whereas the majority (89%) of patients were treated as outpatients or inpatients with standard care. There were 2 patients who died, including a man 71 years of age with diabetes, hypertension, renal failure on dialysis, previous stroke, and obstructive sleep apnea. Hypertension, obesity, and diabetes were the most predominant comorbidities in the overall population. In 11 patients who had complete blood count tests, a total of 2 patients had eosinophilia.
Study limitations included a lack of or incompleteness of several data points, as well as the lack of a meta-analysis on the available data.
Based on findings from this review, the presence of urticarial rashes coupled with “fever should require clinicians to strongly consider COVID-19 testing during the pandemic, as this may the only presenting symptom in some patients,” according to the researchers.
Algaadi SA. Urticaria and COVID-19: a review. Published online September 9, 2020. Dermatol Ther. doi: 10.1111/dth.14290