As dermatologists in Florida, we have heard increasing reports of dermatologic manifestations of COVID-19. The first case series of skin manifestations included 18 Italian patients with rashes that included non-specific red rashes, hives, or chickenpox-like lesions that were often seen on the trunk.1 Other reports have included lesions attributed to blood vessel inflammation that are theorized to be caused by microclots or the virus affecting the blood vessel walls. This has been reported in the media with examples such as “covid toes.”
More research is needed to better determine the relationship between COVID-19 and the skin and whether these findings may assist with early disease detection. To date, collecting cases of dermatologic manifestations of COVID-19 has been challenging, given their relative infrequency. Dermatologists are relying on informal networks to share their experiences. To rapidly and centrally collect these cases from a global network and inform colleagues, the American Academy of Dermatology (AAD) has launched an online COVID-19 registry. A secondary objective is to report how COVID-19 affects patients with pre-existing dermatologic conditions, particularly those receiving immunosuppressive therapies.
A recent study of Chinese and Italian patients with COVID-19 found that approximately 7.8 percent of patients developed skin findings. In the 53 patients who developed a skin finding, the most common finding was a red non-specific rash (70 percent), followed by diffuse hives (26 percent). Two patients (4 percent) had scattered vesicular, chickenpox-like eruptions2.
Most patients who presented with an erythematous rash had only mild itch. There was no correlation between the presence of rash and fever. Involved sites were primarily the trunk and upper limbs, but the head and face were largely spared. Younger patients seem to display more intense manifestations, including darker red, larger hive-like and bruise-like lesions. All rashes were short-lived and resolved spontaneously without specific treatment after an average of three days and were not correlated to COVID-19 severity. Purplish, bruise-like spots were seen in more severe cases.
In conclusion, the medical community is working hard to understand this new disease so that we may better treat and protect the public and our patients.
- Recalcati S. Cutaneous manifestations in COVID-19: a first perspective [Epub ahead of print]. J Eur Acad Dermatol Venereol. 2020; (Published online March 26, 2020).
- A.V. Marzano, G. Genovese, G. Fabbrocini, et al. Varicella-like exanthem as a specific COVID-19-associated skin manifestation: multicenter case series of 22 patients. J Am Acad Dermatol, 83 (1) (2020), pp. 280-285.