DISCUSSION
Coronavirus disease (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 virus; which is a Ribonucleic acid (RNA) virus that invades host cells through one receptor called angiotensin-converting enzyme 2 (ACE2) receptor (12, 13) which is found on small intestine enterocytes, epithelial cells of the lung alveolar, heart, also the endocrine, and neurologic systems (10). Multiple cutaneous symptoms have been seen and documented in people infected with COVID-19. Furthermore, the presence of skin symptoms in COVID-19 has been observed to vary between 0.2 - 29 percent (11); These include an urticarial rash, Morbilliform rash, maculopapular rash, livedo reticularis/racemosa-like pattern, vascular lesions, varicella-like eruptions
The pathogenesis of COVID-19 urticaria is largely underdiagnosed. Still, it might be mediated by the acute systemic inflammatory response to the COVID-19 to acute infection, which results in mast cell activation and the production of pro-inflammatory cytokines (14).
Skin manifestations associated with COVID-19 are often self-limiting and do not lead to complications, and usually, the urticarial rash lasts around Six to eight days and up to ten days (2, 15). Urticarial rashes are mostly noted to occur simultaneously or after the onset of non-cutaneous symptoms. The presence of skin and dermatological symptoms in COVID-19 has been linked to disease severity; a Spanish research linked the characteristics of maculopapular or urticarial lesions to the severity of COVID-19 infection (2); on the other hand, in their literature study of twenty-one patients, Sachdeva et al. claimed that there is an implausible link between cutaneous lesions and COVID-19 infection severity (15).
Most of the patients achieved adequate symptom control with the use of antihistamines treatment only, which can be used until they get resolution (14). Regarding glucocorticoids use, it may be considered short-term additive therapy for severe symptoms refractory to 1 or more antihistamines at maximum doses (16).