Original article
The spectrum of COVID-19–associated dermatologic manifestations: An international registry of 716 patients from 31 countries

https://doi.org/10.1016/j.jaad.2020.06.1016Get rights and content

Background

Coronavirus disease 2019 (COVID-19) has associated cutaneous manifestations.

Objective

To characterize the diversity of cutaneous manifestations of COVID-19 and facilitate understanding of the underlying pathophysiology.

Methods

Case series from an international registry from the American Academy of Dermatology and International League of Dermatological Societies.

Results

The registry collected 716 cases of new-onset dermatologic symptoms in patients with confirmed/suspected COVID-19. Of the 171 patients in the registry with laboratory-confirmed COVID-19, the most common morphologies were morbilliform (22%), pernio-like (18%), urticarial (16%), macular erythema (13%), vesicular (11%), papulosquamous (9.9%), and retiform purpura (6.4%). Pernio-like lesions were common in patients with mild disease, whereas retiform purpura presented exclusively in ill, hospitalized patients.

Limitations

We cannot estimate incidence or prevalence. Confirmation bias is possible.

Conclusions

This study highlights the array of cutaneous manifestations associated with COVID-19. Many morphologies were nonspecific, whereas others may provide insight into potential immune or inflammatory pathways in COVID-19 pathophysiology.

Key words

COVID-19
COVID toes
dermatology
global health
macular erythema
morbilliform
pernio
public health
registry
retiform purpura
SARS-CoV-2
urticarial
vesicular

Abbreviations used

AAD
American Academy of Dermatology
IQR
interquartile range
PCR
polymerase chain reaction
SARS-CoV-2
severe acute respiratory syndrome coronavirus 2

Cited by (0)

Funding sources: None.

Disclosure: Drs Freeman, Lipoff, Rosenbach, Kovarik, Desai, Takeshita, Thiers, Hruza, and Fox are part of the American Academy of Dermatology (AAD) COVID-19 Ad Hoc Task Force. Dr French is president and Dr Lim is a board member of the International League of Dermatological Societies. Dr Thiers is the president of the AAD. Dr Hruza is immediate past president of the AAD. Author McMahon and Dr Harp have no conflicts of interest to declare.

IRB approval status: The registry was reviewed by the Partners Healthcare (Massachusetts General Hospital) IRB and was determined to not meet the definition of human subjects research.

Reprints not available from the authors.

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© 2020 by the American Academy of Dermatology, Inc.