Dermatological manifestations of COVID-19 in Iraqi patients from Al-Qadisiyah province: A retrospective clinical and therapeutic analysis

Since the emergence of the SARS-CoV-2 pandemic, a wide range of cutaneous manifestations have been increasingly recognized as potential indicators of infection. These dermatological features may appear concurrently with or independently of classical systemic symptoms, making them valuable in early diagnosis and clinical assessment. This retrospective study aims to investigate and characterize the dermatological manifestations associated with confirmed cases of COVID-19 among patients treated in Al-Qadisiyah province, Iraq. The study included 150 patients diagnosed with SARS-CoV-2 via RT-PCR at Diwaniya Teaching Hospital between January 2023 and December 2024 Clinical data were collected from medical records, including demographic information, comorbidities, disease severity, laboratory findings, type and timing of skin lesions, treatment modalities, and clinical outcomes. Analysis revealed that cutaneous involvement was present in a significant proportion of patients, with the most common types being maculopapular rash (34%), urticarial lesions (22%), acral erythematous changes resembling pseudo-chilblains (18%), vesicular eruptions (12%), livedo reticularis (9%), and petechial or purpuric lesions (5%). The majority of these dermatological signs appeared either simultaneously with or within one week of the onset of systemic symptoms such as fever, cough, and dyspnea. Importantly, there was a statistically significant association between the presence of skin lesions and the severity of systemic illness. Patients with moderate to severe respiratory involvement were more likely to develop cutaneous manifestations compared to those with mild disease. Laboratory investigations showed elevated inflammatory markers, particularly CRP and IL-6, as well as increased D-dimer levels in patients presenting with livedoid or purpuric lesions, suggesting an underlying hypercoagulable and pro-inflammatory state. Clinically, the majority of patients showed satisfactory improvement with supportive and symptomatic treatment. Hives responded to antihistamines, while topical corticosteroids improved maculopapular rash. However, livedo and purpuric lesions required additional therapeutic measures through low-dose anticoagulation and use of systemic corticosteroids as they were more associated with microvascular problems during the acute phase of the disease. This current study reinforces the recognition of acute dermatoses as part of a clinical evaluation in suspected or confirmed cases of SARS-CoV-2 infection, particularly the atypical presentation of COVID-19. Additionally, it has highlighted certain morphologies, specifically livedo reticularis and purpura, which may serve as witness to the more severe nature of disease and as a window of opportunity for assessment of coagulopathy and immune response. In conclusion, cutaneous manifestations of COVID-19 infection are not uncommon amongst Iraqi patients, especially in Al-Qadisiyah's population. This adds to the evidence of the link between cutaneous signs and disease severity, and provides practitioners with some useful observations for their diagnostic and treatment management of cutaneous involvement of COVID-19.