Classification of the cutaneous manifestations of
            <scp>COVID</scp>
            ‐19: a rapid prospective nationwide consensus study in Spain with 375 cases

Galván-Casas, Cristina; Català, Alba; Hernández, G. Carretero; Rodríguez‐Jiménez, Pedro; Fernández‐Nieto, Diego; Lario, Ana Rodríguez‐Villa; Fernández, I. Navarro; Ruiz‐Villaverde, Ricardo; Falkenhain‐López, Daniel; Llamas‐Velasco, Mar; García‐Gavín, J.; Baniandrés, Ofelia; González‐Cruz, Carlos; Morillas-Lahuerta, Víctor; Cubiró, Xavier; Figueras‐Nart, Ignasi; Selda-Enríquez, Gerald; Romaní, Jorge; Fustà‐Novell, Xavier; Melián-Olivera, Ana; Riesco, Mónica Roncero; Burgos-Blasco, Patrícia; Ortigosa, Joaquim Sola; Rodríguez, Marta Feito; García‐Doval, I.

doi:10.1111/bjd.19163

Cited by 1,137 publications

(1,949 citation statements)

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“…Patients with PC typically required less treatments than those with LPN, EMR, UR and VR skin ndings. 13 Of note, these PC lesions were largely unrelated to cold exposure (secondary to social isolation and stay-at-home orders) or a prior history of Raynaud's disease. 9,20,32,33,34,36 As such, these cutaneous ndings may be categorized as COVID-19-induced pseudo-chilblains rather than primary pernio disease.…”

Section: Discussionmentioning

confidence: 92%

“…Unsurprisingly, these vascular rashes were then associated with higher rates of hospital admission and mechanical ventilation compared to EMR, UR, VR and PC. 13 Given their correlation to disease severity, these LPN ndings might represent a COVID-19-speci c complication in which the virus-induced pro-thrombotic state provokes vascular occlusion and ischemia. 38 Consequently, these rashes may be a useful prognostic marker that can help guide medical management.…”

Section: Discussionmentioning

confidence: 99%

“…Case fatality rates ranged from 0.0% to 13.6%. 8,13,30 For studies that examined a larger cohort of COVID-19+ patients (both with cutaneous and extracutaneous symptoms), the prevalence of skin symptoms ranged from 4.9-20.4%. 3,12 3.2 Characteristics of cutaneous symptoms Table 2 summarizes the characteristics of the cutaneous symptoms described in the COVID-19 literature.…”

Section: Study Characteristics and Patient Demographicsmentioning

confidence: 99%

“…Summary of Rashes by Location* Studies by Bouaziz and Galvan Casas excluded because of inability to extract exact data 4,13. …”

mentioning

confidence: 99%

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Cutaneous Manifestations of COVID-19: A Systematic Review

Daneshgaran

Dubin

Gould

2020

Preprint

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Background: The COVID-19 pandemic has affected 4.5 million people and killed over 300,000 patients. Although this virus primarily causes respiratory symptoms, an increasing number of cutaneous manifestations associated with this disease have been reported.Objective: The aim of this review was to collate and categorize the dermatologic findings reported in COVID-19 patients and identify specific lesions that may facilitate diagnosis and prognostication.Methods: A systematic review of the PubMed database was conducted on May 14th, 2020 using the search terms “Covid-19 skin,” “Covid-19 rash,” “Covid-19 exanthem,” and “Covid-19 chilblains.” Peer-reviewed publications containing original COVID-19 patient cases and a discussion of the associated cutaneous findings were included in the analysis.Results: The literature search identified 115 records, of which 34 publications describing 996 dermatologic patients were included. Case reports (n=15), case series (n=10) and observational studies (n=7) were the most common publication types. Pseudo-chilblains (PC) was the most frequent lesion identified (40.4% of cases), appearing in young adults (mean age, MA, 23.2 years) after the onset of extracutaneous COVID-19 symptoms (55/100 patients). Erythematous maculopapular rashes (EMR) affected 21.3% of patients, most frequently impacting middle-aged adults (MA 53.2 years) and occurring at the same time as non-cutaneous symptoms (110/187 patients). Vesicular rashes (VR) affected 13.0% of patients, appearing in middle-aged adults (MA 48.3 years) after the onset of other symptoms (52/84 patients). Urticarial rashes (UR) affected 10.9% of patients, appearing in adults (MA 38.3 years) and occurring at the same time as non-cutaneous symptoms (46/78 patients). Vascular rashes resembling livedo/purpura/necrosis (LPN) were uncommon (4% of cases), appearing in elderly patients (MA 77.5 years) and occurring at the same time as non-cutaneous COVID-19 symptoms (18/29 patients). Erythema multiforme-like eruptions (EME), although infrequent (3.7% of cases), affected mostly children (MA 12.2 years).Conclusions: VR may suggest an initial diagnosis of COVID-19, PC may be most appropriate for epidemiological uses, and LPN may be a useful prognostic marker for severe disease. As a potential correlate to disease severity, prognosis, or infectibility, it is critical that all health care professionals be well-versed in these increasingly common cutaneous manifestations of COVID-19.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Study Characteristics and Patient Demographicsmentioning

confidence: 99%

“…Summary of Rashes by Location* Studies by Bouaziz and Galvan Casas excluded because of inability to extract exact data 4,13. …”

mentioning

confidence: 99%

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Cutaneous Manifestations of COVID-19: A Systematic Review

Daneshgaran

Dubin

Gould

2020

Preprint

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“…A red collar may be seen along all of the gingival margin. 25 The information summarized above indicates that clinical evidence and common sense should prevail in decision making. 26 In cancer cases, especially in patients with carcinomas of the upper airways and digestive tract, for which the treatment of choice is surgical, COVID-19 infection should be investigated at between 24 and 48 hours before surgery.…”

Section: Discussionmentioning

confidence: 99%

The COVID-19 Pandemic and Planetary Health. A Critical Review of Epidemiology, Prevention, Clinical Characteristics and Treatments for Oral, Head and Neck Health Professionals. Do We Have a Roadmap?

Jotz

Stein

Sirena

et al. 2020

Int Arch Otorhinolaryngol

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Introduction Coronavirus disease 19 (COVID-19) is potentially the greatest global public health crisis of this century. This disease emerged as an outbreak of pneumonia of unknown cause in Wuhan, the capital city of the Hubei province in China, in December 2019. Otolaryngologists, head and neck surgeons and dentists are at an increased risk of occupational disease. Objective The present review summarizes currently published evidence of Covid-19 epidemiology, clinical characteristics, treatment and prevention. No proven effective treatments for this disease currently exist. Data Synthesis COVID-19 started from a zoonotic transmission event associated with a large seafood market that also traded in live wild animals, and it soon became clear that efficient person-to-person transmission was also occurring. Symptoms are varied, and not all patients develop all of them. Conclusion Social distancing seems to have been successful in several places in the world. However, this recommendation alone is not enough to contain the disease, and it is not a long-term solution. Large-scale testing by health professionals of representative samples of the population may give an estimate of the progression of the disease. Different treatments are under test and bring hope of a cure to the population. However, no current treatments (April 27, 2020) have been proven to be the key to success in the treatment of patients with COVID-19. Planetary health is a useful concept to understand the current drivers of this pandemic and to draw a roadmap for science and healthcare that may guide actions to fight economic depression and ensure a healthy recovery.

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Dermatology and COVID-19

Shinkai

Bruckner

2020

JAMA

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Even early in the coronavirus disease 2019 (COVID-19) pandemic, it was clear that dermatologists had an important role in the management of patients. Although initial case series rarely documented skin changes, possibly due to the inability to perform a complete skin examination, subsequent research has suggested significantly higher rates of skin involvement. 1 The true prevalence of skin findings, the uncertainty of whether these represented direct infection or were associated with systemic illness (eg, reactive or due to medications), and how best to manage them were among the many questions challenging the evolving understanding of these cutaneous manifestations. This has been an important opportunity for dermatologists to learn and contribute. 2 What are the current priorities in dermatology research and clinical care as the COVID-19 pandemic progresses? Skin FindingsA broad spectrum of skin manifestations has been reported in association with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, spanning almost every inflammatory pattern. The variability of skin findings seen is substantial compared with other viral infections that typically present with characteristic skin patterns. The seemingly high (estimated as high as 20% in one study) prevalence in adults, who rarely present with viral exanthems, is also notable. Understanding the true prevalence of skin findings is complicated by the lack of testing, as well as likely reporting bias in publication. SARS-CoV-2 infection disproportionately affects people

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Classification of the cutaneous manifestations of COVID ‐19: a rapid prospective nationwide consensus study in Spain with 375 cases

Abstract: The analysis and technical support for this study were done by the Spanish Academy of Dermatology (Research Unit). C. Galv an Casas and A. Catal a contributed equally as first authors.

Cited by 1,137 publications

References 16 publications

Cutaneous Manifestations of COVID-19: A Systematic Review

Cutaneous Manifestations of COVID-19: A Systematic Review

The COVID-19 Pandemic and Planetary Health. A Critical Review of Epidemiology, Prevention, Clinical Characteristics and Treatments for Oral, Head and Neck Health Professionals. Do We Have a Roadmap?

Dermatology and COVID-19

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