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The spectrum of COVID-19–associated dermatologic manifestations: An international registry of 716 patients from 31 countries - 08/09/20

Doi : 10.1016/j.jaad.2020.06.1016 
Esther E. Freeman, MD, PhD a, b, , Devon E. McMahon, BA a, Jules B. Lipoff, MD c, Misha Rosenbach, MD c, Carrie Kovarik, MD c, Seemal R. Desai, MD d, e, Joanna Harp, MD f, Junko Takeshita, MD, PhD, MSCE c, Lars E. French, MD g, h, Henry W. Lim, MD i, Bruce H. Thiers, MD j, George J. Hruza, MD, MBA k, Lindy P. Fox, MD l
a Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 
b Medical Practice Evaluation Center, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts 
c Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania 
d Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas, Texas 
e Innovative Dermatology, Plano, Texas 
f Department of Dermatology, Weill Cornell Medicine, New York, New York 
g Department of Dermatology, University Hospital, Munich University of Ludwig Maximilian, Munich, Germany 
h Department of Dermatology, Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida 
i Department of Dermatology, Henry Ford Health System, Detroit, Michigan 
j Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina 
k Department of Dermatology, St. Louis University, St Louis, Missouri 
l Department of Dermatology, University of California San Francisco, San Francisco, California 

Correspondence to: Esther Freeman, MD, PhD, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114.Massachusetts General Hospital55 Fruit StBostonMA02114

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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 the 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, whereas retiform purpura presented exclusively in ill, hospitalized patients.

Limitations

We cannot estimate incidence or prevalence. Confirmation bias is possible.

Conclusions

This study highlights the array of cutaneous manifestations associated with COVID-19. Many morphologies were nonspecific, whereas others may provide insight into potential immune or inflammatory pathways in COVID-19 pathophysiology.

Le texte complet de cet article est disponible en PDF.

Key words : COVID-19, COVID toes, dermatology, global health, macular erythema, morbilliform, pernio, public health, registry, retiform purpura, SARS-CoV-2, urticarial, vesicular

Abbreviations used : AAD, IQR, PCR, SARS-CoV-2


Plan


 Funding sources: None.
 Disclosure: Drs Freeman, Lipoff, Rosenbach, Kovarik, Desai, Takeshita, Thiers, Hruza, and Fox are part of the American Academy of Dermatology (AAD) COVID-19 Ad Hoc Task Force. Dr French is president and Dr Lim is a board member of the International League of Dermatological Societies. Dr Thiers is the president of the AAD. Dr Hruza is immediate past president of the AAD. Author McMahon and Dr Harp have no conflicts of interest to declare.
 IRB approval status: The registry was reviewed by the Partners Healthcare (Massachusetts General Hospital) IRB and was determined to not meet the definition of human subjects research.
 Reprints not available from the authors.


© 2020  American Academy of Dermatology, Inc.. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 83 - N° 4

P. 1118-1129 - octobre 2020 Retour au numéro
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