Association Between Dengue Skin Rash and Disease Outcome in A Tertiary Care Hospital.

Objective: The objective of this research work is to build upon existing knowledge by exploring the relationship between dengue skin rashes and disease course in a tertiary healthcare center. Methods: This descriptive cross sectional study was conducted in Dermatology department at HBS General Hospital, Islamabad. from January 2024 to August 2024. Total 188 confirmed dengue fever patients was performed. Researchers documented demographic information together with clinical features as well as laboratory findings and disease outcomes of all these patients. Dermatologists evaluated the presence, morphology and distribution of skin rashes. Disease severity was classified according to the 2009 WHO dengue guidelines. Results: Skin rash was observed in 17.6% (n = 33) of patients, with maculopapular rash being the most common type (75.8%, n = 25). Patients with skin rash had significantly milder disease outcomes. 87.9% of the patients with skin rash had non severe dengue while only 12.1% of patients with skin rash had severe dengue. While in the patients without skin rash, 69% had mild disease while 31% had severe dengue (p <0.001). Laboratory findings revealed higher platelet counts (87,000 ± 23,000/?L vs. 53,000 ± 18,000/?L, p < 0.001) and lower hematocrit levels (37.9 ± 4.1% vs. 42.2 ± 5.0%, p = 0.002) in patients with rash. The patients with skin rash required less hospitalization of 4.4 ± 1.5 days compared to 6.6 ± 2.1 days (p < 0.001), while the occurrence of complications (9.1% vs. 25.8%) including hemorrhage and organ failure (p = 0.003) also showed lower rates.  Multivariate analysis identified the absence of skin rash as an independent predictor of severe dengue (aOR = 3.18, 95% CI: 1.68–6.02, p < 0.001). Conclusion: The presence of skin rash in dengue patients is associated with milder disease outcomes, which includes higher platelet counts, lower hematocrit levels, shorter hospitalization, and fewer complications. Routine clinical practice that includes dermatological examinations allows better risk stratification for dengue patients.