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Based on data from a nationwide dermatologist survey, these authors from Spain report five categories of cutaneous manifestations associated with COVID-19. Patients with the most severe disease were excluded from this study due to difficulty obtaining consent. Final analysis included 375 patients, most with photographs of their cutaneous lesions. The five clinical patterns included: pseudo-chilblain (19%), other vesicular eruptions (9%), urticarial lesions (19%), other maculopapules (47%), and livedo or necrosis (6%). There were also reports of increased numbers of herpes zoster cases in patients with COVID-19.
While pseudo-chilblain lesions tended to affect younger patients with less severe disease, vesicular lesions appeared more in middle-aged patients with intermediate severity of disease. Urticarial, maculopapular, and livedoid/necrotic lesions were all associated with more severe disease. A mortality rate of 10% was noted in the livedoid/necrotic group.
– Caitlyn T. Reed, MD
This abstract is available on the publisher's site.
Cutaneous manifestations of COVID-19 disease are poorly characterized.
To describe the cutaneous manifestations of COVID-19 disease and to relate them to other clinical findings METHODS: Nationwide case collection survey of images and clinical data. Using a consensus, we described 5 clinical patterns. We later described the association of these patterns with patient demographics, timing in relation to symptoms of the disease, severity, and prognosis.
Lesions may be classified as acral areas of erythema with vesicles or pustules (Pseudo-chilblain) (19%), other vesicular eruptions (9%), urticarial lesions (19%), maculopapular eruptions (47%) and livedo or necrosis (6%). Vesicular eruptions appear early in the course of the disease (15% before other symptoms). The pseudo-chilblain pattern frequently appears late in the evolution of the COVID-19 disease (59% after other symptoms), while the rest tend to appear with other symptoms of COVID-19. Severity of COVID-19 shows a gradient from less severe disease in acral lesions to most severe in the latter groups. Results are similar for confirmed and suspected cases, both in terms of clinical and epidemiological findings. Alternative diagnoses are discussed but seem unlikely for the most specific patterns (pseudo-chilblain and vesicular).
We provide a description of the cutaneous manifestations associated with COVID-19 infection. These may help clinicians approach patients with the disease and recognize paucisymptomatic cases.
Classification of the Cutaneous Manifestations of COVID-19: A Rapid Prospective Nationwide Consensus Study in Spain With 375 Cases
Br J Dermatol 2020 Apr 29;[EPub Ahead of Print], C Galván Casas, A Català, G Carretero Hernández, P Rodríguez-Jiménez, D Fernández Nieto, A Rodríguez-Villa Lario, I Navarro Fernández, R Ruiz-Villaverde, D Falkenhain, M Llamas Velasco, J García-Gavín, O Baniandrés, C González-Cruz, V Morillas-Lahuerta, X Cubiró, I Figueras Nart, G Selda-Enriquez, J Romaní, X Fustà-Novell, A Melian-Olivera, M Roncero Riesco, P Burgos-Blasco, J Sola Ortigosa, M Feito Rodriguez, I García-Doval