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

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 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, while retiform purpura presented exclusively in ill, hospitalized patients. Limitations: We cannot estimate incidence or prevalence. Confirmation bias is possible. Conclusion: This study highlights the array of cutaneous manifestations associated with COVID-19. Many morphologies were non-specific, while others may provide insight into potential immune or inflammatory pathways in COVID-19 pathophysiology.