Cutaneous T‐cell lymphoma after chronic exposure to hydrochlorothiazide: pharmacovigilance analysis from the RADAR (Research on Adverse Drug events And Reports) Program

Of the 382 patients diagnosed with COVID-19, 70 (18.3%) exhibited dermatological symptoms, that was similar to the literature. Most common complaints were rash (n = 37), redness (n = 29), bruising (n = 13) and wounds (n = 7; Table 1). The number of patients with more than one dermatological symptom was 13/70. Itching occurred in 58 (15.2%) patients, of which 28 did not show any additional symptoms. Similar symptoms were also seen as reactions related to drug use. Whether the symptoms started before or after the COVID-19 treatment was also examined in the present study. Of the patients, 31 stated that the symptoms started before the treatment and 39 said after the treatment. It was necessary to distinguish whether the complaints, which started after the treatment, were due to infection or drug use. The localization and distribution of lesions during a dermatological examination are very important. Sachdeva et al. described lesion localization on hands and feet on the body (69.4%). Recallti et al. identified the main affected area as the body in 18 patients with dermatological findings. The lesions were observed mostly on lower extremities, upper extremities and head–neck region (n = 32/70, 30/70 and 22/70, respectively) in our study. A study on 507 patients reported that 272 (60.44%) of the patients with dermatological symptoms were women. Similar to this study, more women described dermatological symptoms in our study (62.8%). Personal hygiene has become very important during the pandemic. Frequent washing of the hands is recommended for preventing contamination. In the present study, 6.8% of the patients developed hand eczema and 11.5% an intolerance against the soap. In addition, 23% of the patients reported dryness of the skin after the infection, and 9.4% reported redness and itching due to the use of masks. Parameters, such as fever during the COVID-19 infection, length of hospital stay, intensive care and healing time, give an idea about the severity of the disease. Recallti et al. did not find any correlation between cutaneous findings and the severity of the disease. However, in the present study, fever, hospitalization, need for intensive care and length of hospital stay were found to be significantly higher in patients with dermatological symptoms, suggesting a correlation between the severity of COVID-19 infection and dermatological symptoms (Table 2). Dermatological symptoms occur in approximately one-fifth of patients diagnosed with the COVID-19 infection, regardless of the severity of the disease. It is important to inquire about dermatological symptoms and systemic findings in these patients. Multicenter studies with larger patient populations can help in providing more details in this regard.