The Exchange

Commentary and Observations from
the Medical Front Lines

Cutaneous Manifestations of COVID-19

Cutaneous Manifestations of COVID-19

The COVID-19 virus has certainly perplexed the medical world with its various clinical presentations, responses to treatment, and the devastating toll it has taken on patients and healthcare workers. The virus can affect nearly every organ in the body, including the largest: the skin.

Since 2019, dermatology providers have tried to categorize the various cutaneous manifestations of COVID-19 to help clinicians more effectively recognize dermatologic features of the virus. The American Academy of Dermatology and the International League of Dermatologic Societies created a registry of more than 170 patients with laboratory-confirmed COVID-19 who presented with skin findings. The most common cutaneous presentations noted were:

  • Exanthematous (morbilliform) rash (22%): measles-like rash, primarily on the trunk
  • Pernio (chilblain)-like acral lesions (18%): red-purple macules or papules on fingers, elbows, toes or feet
  • Urticaria (16%): hives or welts, dermatographism
  • Macular erythema (13%): livedo reticularis-like patches (red-purple macules and patches)
  • Vesicular eruptions (11%): tiny vesicles resembling varicella-like eruptions
  • Papulosquamous eruption (9.9%): pink-red papules and patches, sometimes scaly
  • Retiform purpura (6.4%): purple-blue-black patches and papules representing vascular damage

Of the patients with cutaneous presentations in the registry, 60% also had fever and cough. Recognition of skin findings by clinicians can lead to an earlier diagnosis of COVID-19, and with appropriate therapy, may positively affect the course of the disease.


Filed under: Dermatology, Infectious Diseases

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