Pernio-like skin lesions associated with COVID-19: a case series of 318 patients from 8 countries

Abstract

Background: Increasing evidence suggests pernio-like lesions are cutaneous manifestations of COVID-19. Objective: To describe clinical and pathologic findings of pernio-like lesions in confirmed or suspected COVID-19 cases. Methods: An international dermatology registry was circulated to healthcare providers worldwide through the American Academy of Dermatology (AAD), International League of Dermatologic Societies (ILDS), and other organizations. Results: We documented 505 patients with dermatologic manifestations associated with COVID-19, including 318 (63%) with pernio-like lesions. Patients with pernio-like lesions were generally young and healthy, with relatively mild COVID-19. Of 318 cases confirmed or suspected as COVID-19 by providers, twenty-three cases (7%) were laboratory-confirmed COVID-19 positive, and 20 others (6%) were close contacts of confirmed COVID19 cases. Given current testing criteria, many patients lacked COVID-19 testing access. For 55% of patients, pernio-like lesions were their only symptom. In patients with other COVID-19 symptoms, pernio-like lesions typically appeared after other symptoms. Pernio-like lesions lasted a median of 14 days (IQR 10-21). Limitations: A case series cannot estimate population level incidence or prevalence. Additionally, there may be confirmation bias in reporting. We cannot exclude an epiphenomenon. Conclusions: Pernio-like skin changes of the feet and hands, without another explanation, may suggest COVID19 infection and should prompt confirmatory testing.