Isolated cutaneous manifestation of COVID-19 managed by telemedicine

Objectives: This paper is a case report of a COVID-19 patient with a confirmed diagnosis of COVID-19 who had a medical evaluation by Telemedicine (TM). She presented with an isolated cutaneous manifestation and was examined by a remote general practitioner, having diagnosis and treatment guided. The correct evaluation of COVID-19 cutaneous manifestation is a challenge, and the feasibility of TM diagnosis is still uncertain. We aim to demonstrate the effectiveness of teleconsultation in a dermatological manifestation during a pandemic. Material and Methods: Retrospective data compilation from patient’s medical record and the patient signed the consent form. Results: The initial clinical presentation was a diffuse pruritic macules in the abdomen, which motivated the patient to seek face-to-face care in the emergency department on the first day of symptoms. The initial hypothesis was an unspecified allergic reaction. Due to the context of the pandemic, blood tests and RT-PCR (nasopharyngeal swab) were performed for COVID-19. The patient was discharged medicated with an anti allergy and instructed to check the results of the test within 24 hours and have a medical reassessment if necessary. She was re-evaluated by TM the following day, the diagnosis of acute infection by COVID-19 was confirmed (swab positive), there was no manifestation of other symptoms and it was possible to accurately re-evaluate the skin lesions remotely. The patient had a diffuse morbilliform rash with local angioedema. The patient received specific orientations according to institutional guidelines and maintenance of dermatological symptomatic treatment. After 3 weeks, in a new reassessment by TM, there was confirmation of the resolution of the skin condition and absence of other symptoms during this period. Conclusion: The medical evaluation by TM allowed the interpretation of the elementary skin lesion, decision making and adequate guidance. The isolated cutaneous manifestation can be a manifestation of COVID-19 and it is feasible to be diagnosed by teleconsultation, reinforcing the need to expand the MT program for the initial evaluation of acute patients.