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).