Drug eruption: A mimicker of Coronavirus disease-2019 rash

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Drug eruption: A mimicker of Coronavirus disease-2019 rash [Turkderm-Turk Arch Dermatol Venereol]

Turkderm-Turk Arch Dermatol Venereol. 2022; 56(1): 34-38 | DOI: 10.4274/turkderm.galenos.2021.29904

Drug eruption: A mimicker of Coronavirus disease-2019 rash

T�lin Ergun¹, Ilkay Ergen�², Seda Seven³, Dilek Se�kin¹, Elif C�mert �zer¹, Meryem Akta�¹, Elif T�kenmez Tigen⁴
¹Marmara University Faculty of Medicine, Department of Dermatology; �stanbul, Turkey
²Marmara University Faculty of Medicine, Department of Gastroenterology; �stanbul, Turkey
³Marmara University Faculty of Medicine, Department of Anesthesiology and Intensive Care; �stanbul, Turkey
⁴Marmara University Faculty of Medicine, Department of Clinical Microbiology and Infectious Diseases; �stanbul, Turkey

Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infections can be associated with several cutaneous lesions, among which maculopapular rash is the most common. A maculopapular rash can also be induced by medications used for Coronavirus disease-2019 (COVID-19) treatment. The distinction between viral rash and drug eruption may be difficult especially in case of several medication use for COVID-19. Thus, this study aimed to describe cutaneous manifestations in six patients with COVID-19 and highlight clues for distinguishing SARS-CoV-2-related rash and drug eruption. Between March and June 2020, 1,492 patients were hospitalized for COVID-19 and treated with hydroxychloroquine in Marmara University Hospital. Among them, six cases were consulted for possible COVID-19-related rash or drug reaction. Hydroxychloroquine was given as monotherapy in one patient. All six patients developed an erythematous, symmetrical, and maculopapular eruption that mainly affected the trunk, axilla, and genitocrural region, 5-21 days after the onset of COVID-19 symptoms. Five patients developed rash in 4-11 days after treatment completion. Pruritus was severe. All were treated with topical corticosteroids and oral antihistamines, which provided partial relief. The resolution of the eruption was typically slow, which took a few weeks. A long period between the COVID-19 symptoms and the eruption, as well as slow recovery, is in favor of drug eruption. The effects of co-existent viral infection, a well-known promoting drug eruption factor, in facilitating adverse drug reaction in patients with COVID-19 needs further observations and research.

Keywords: Anti-malarial, COVID-19, cutaneous adverse drug reaction, hydroxychloroquine

�la� er�psiyonu: Koronavir�s hastal��-2019 d�k�nt�s�n�n bir taklit�isi

T�lin Ergun¹, Ilkay Ergen�², Seda Seven³, Dilek Se�kin¹, Elif C�mert �zer¹, Meryem Akta�¹, Elif T�kenmez Tigen⁴
¹Marmara �niversitesi T�p Fak�ltesi, Deri ve Z�hrevi Hastal�klar Anabilim Dal�, �stanbul, T�rkiye
²Marmara �niversitesi T�p Fak�ltesi, Gastroenteroloji Anabilim Dal�, �stanbul, T�rkiye
³Marmara �niversitesi T�p Fak�ltesi, Anesteziyoloji ve Yo�un Bak�m Anabilim Dal�, �stanbul, T�rkiye
⁴Marmara �niversitesi T�p Fak�ltesi, Klinik Mikrobiyoloji ve �nfeksiyon Hastal�klar� Anabilim Dal�, �stanbul, T�rkiye

�iddetli akut solunum yolu sendromu-koronavir�s-2 (SARS-CoV-2) enfeksiyonu �e�itli kutan�z lezyonlara sebep olabilir. Bunlar i�erisinde en s�k g�r�leni mak�lopap�ler d�k�nt�d�r. Mak�lopap�ler d�k�nt�, Koronavir�s hastal��-2019 (COV�D-19) hastal��n�n tedavisi i�in kullan�lan ila�larla da ind�klenebilir. COV�D-19 hastal�� i�in �e�itli ila�lar�n kullan�ld�� durumlarda, viral d�k�nt� ile ila� er�psiyonu aras�nda ay�r�m yapmak zor olabilir. Bu �al��man�n amac�, COV�D-19 olan alt� hastada kutan�z bulgular� tan�mlamak ve SARS-CoV-2 ile ili�kili d�k�nt� ile ila� er�psiyonunu ay�rt etmek i�in ipu�lar�n� vurgulamakt�r. Mart ve Haziran 2020 aras�nda, Marmara �niversitesi Hastanesi�ne yat�r�larak hidroksiklorokin ile tedavi edilen 1.492 COV�D-19 olgusu i�inde, olas� COV�D-19 d�k�nt�s� veya ila� reaksiyonu olan alt� tanesi kons�lte edildi. Bir hastada hidroksiklorokin monoterapi olarak verilmi�ti. Alt� hastan�n t�m�nde, COV�D-19 semptomlar�n�n ba�lang�c�ndan 5 ile 21 g�n sonra, ba�l�ca g�vdeyi, aksillay� ve genitokrural b�lgeyi etkileyen, eritemat�z, simetrik, mak�lopap�ler bir er�psiyon geli�mi�ti. Be� hastada, tedavinin tamamlanmas�ndan 4 ile 11 g�n sonra d�k�nt� ortaya ��km��t�. Ka��nt� �iddetliydi. Hastalar�n t�m�, topikal kortikosteroidler ve oral antihistaminiklerle k�smi d�zelme g�sterdi. Er�psiyonun d�zelmesi tipik olarak yava� olup birka� hafta s�rd�. COV�D-19 semptomlar� ile er�psiyonun ortaya ��k�� aras�ndaki zaman�n uzun olmas� ve yava� d�zelme, ila� er�psiyonu lehinedir. E�lik eden viral enfeksiyonun ila� er�psiyonu ortaya ��k��n� kolayla�t�r�c� bir fakt�r oldu�u iyi bilinmektedir. COV�D-19 hastalar�nda da viral enfeksiyon varl��nda ila� reaksiyonu ortaya ��k��n�n kolayla�abilece�i konusu, ileri g�zlemler ve ara�t�rmalarla g�sterilmelidir.

Anahtar Kelimeler: Antimalaryal, COV�D-19, kutan�z ila� reaksiyonu, hidroksiklorokin

T�lin Ergun, Ilkay Ergen�, Seda Seven, Dilek Se�kin, Elif C�mert �zer, Meryem Akta�, Elif T�kenmez Tigen. Drug eruption: A mimicker of Coronavirus disease-2019 rash. Turkderm-Turk Arch Dermatol Venereol. 2022; 56(1): 34-38

Corresponding Author: T�lin Ergun, T�rkiye

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