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

Esther E. Freeman, Devon E. McMahon, Jules B. Lipoff, Misha Rosenbach, Carrie Kovarik, Seemal R. Desai, Joanna Harp, Junko Takeshita, Lars E. French, Henry W. Lim, Bruce H. Thiers, George J. Hruza, Lindy P. Fox

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1118-1129
Number of pages12
JournalJournal of the American Academy of Dermatology
Volume83
Issue number4
DOIs
StateAccepted/In press - 2020

Keywords

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

ASJC Scopus subject areas

  • Dermatology

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  • Cite this

    Freeman, E. E., McMahon, D. E., Lipoff, J. B., Rosenbach, M., Kovarik, C., Desai, S. R., Harp, J., Takeshita, J., French, L. E., Lim, H. W., Thiers, B. H., Hruza, G. J., & Fox, L. P. (Accepted/In press). The spectrum of COVID-19–associated dermatologic manifestations: An international registry of 716 patients from 31 countries. Journal of the American Academy of Dermatology, 83(4), 1118-1129. https://doi.org/10.1016/j.jaad.2020.06.1016