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

Freeman, Esther E.; McMahon, Devon E.; Lipoff, Jules B.; Rosenbach, Misha; Kovarik, Carrie L.; Desai, Seemal R.; Harp, Joanna; Takeshita, Junko; French, Lars E.; Lim, Henry W.; Thiers, B.H.; Hruza, George J.; Fox, Lindy P.

doi:10.1016/j.jaad.2020.06.1016

Cited by 339 publications

(625 citation statements)

References 30 publications

(53 reference statements)

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“… 17 Morbilliform, urticarial, pseudochilblain, vesicular, papulosquamous, pernio-like, livedoid, and necrotic lesions have all been described in large case series and systematic reviews. 16 , 17 , 18 , 19 Pediatric patients with COVID-19 who do not have MIS-C have been described as having similar eruptions as adults, such as acral chilblain-like 20 , 21 , generalized papulovesicular, maculopapular, and morbilliform eruptions. 17 Cutaneous findings specific to MIS-C, however, are not as well outlined in the current literature.…”

Section: Dermatologic Presentationmentioning

confidence: 99%

Dermatologic manifestations of COVID-19-associated multisystem inflammatory syndrome in children

Brumfiel

DiLorenzo

Petronic‐Rosic

2021

Clinics in Dermatology

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Multisystem inflammatory syndrome in children (MIS-C) affects a small percentage of pediatric patients infected with COVID-19 and is characterized by fever, laboratory evidence of inflammation, multisystem involvement, and severe illness necessitating hospitalization. Skin findings are often present in these patients and while initially compared to Kawasaki disease, likely represent distinct phenomena and overall remain poorly characterized. In this retrospective review of 34 case reports and series, we identified cutaneous manifestations documented in 417 of 736 patients (57%) with MIS-C associated with COVID-19. “Rash” was the sole descriptor of skin findings in nearly half of patients. Case reports and smaller case series provided more detail, outlining a broad range of lesion morphologies (polymorphic, maculopapular, morbilliform, erythrodermic, urticarial, reticular, petechial, purpuric) in variable anatomic distribution. More thorough descriptions of dermatologic manifestations in patients with MIS-C are warranted to better characterize this syndrome, as they may lend important insight into pathogenic mechanisms of disease.

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Section: Dermatologic Presentationmentioning

confidence: 99%

Dermatologic manifestations of COVID-19-associated multisystem inflammatory syndrome in children

Brumfiel

DiLorenzo

Petronic‐Rosic

2021

Clinics in Dermatology

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“…The most common reported dermatologic presentations in confirmed or highly suspected patients are morbilliform, pernio-like, urticaria, macular erythema, vesicular, papulosquamous and retiform purpura. ( Freeman et al, 2020 ) We had limitation of antiganglioside antibody testing to identify a specific target of autoimmune process and also SARS-Cov-2 PCR on CSF, but it has been reported negative in all the other published cases ( Caress et al, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

COVID-19 associated with sensorimotor polyradiculoneuropathy and skin lesions: A case report

Boostani

Talab

Meibodi

et al. 2021

Journal of Neuroimmunology

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A novel betacoronavirus,SARS-CoV-2, causes Coronavirus disease 2019 typically presented with fever, myalgia and cough, but central and peripheral nervous system manifestations such as stroke, encephalitis and Guillain-Barre-Syndrome are being increasingly reported. Acute immune-mediated polyradiculoneuropathy (Guillain-Barre-Syndrome) mostly occurs after viral or bacterial infections, presenting with ascending flaccid tetraparesis, dysautonomia and respiratory failure. We reported a patient with COVID-19 (confirmed with Lung HRCT scan and positive SARS-CoV-2 PCR) who developed acute progressive flaccid tetraparesis and maculopapular pigmented plaques on the limbs, 2 weeks after respiratory symptoms. He was treated with IVIg as the Electrophysiologic study showed sensorimotor polyradiculoneuropathy with demyelinating features and skin biopsy showed interface dermatitis and vasculopathic reaction. The causal association between Guillen-Barre-Syndrome and COVID-19 is uncertain yet, but neurologists should be aware of early diagnosis and treatment of acute polyradiculoneuropathy which may cause fatal dysautonomia and respiratory failure in the context of COVID19 pandemic.

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“…Since then, considerable research has been focused on the virus’ rash-related symptoms, and a variety of skin lesions associated with COVID-19 have been described [ 14 – 19 ]. Recently, findings of an international registry from 31 countries, collecting 716 cases of new-onset cutaneous manifestations in patients with confirmed or suspected COVID-19, were published.…”

Section: Introductionmentioning

confidence: 99%

“…Recently, findings of an international registry from 31 countries, collecting 716 cases of new-onset cutaneous manifestations in patients with confirmed or suspected COVID-19, were published. Authors described the following skin lesions in patients with confirmed COVID-19: morbilliform (22%), pernio-like (18%), urticarial (16%), macular erythema (13%), vesicular (11%), papular-squamous (9.9%), and retiform purpura (6.4%) [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

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An itchy erythematous papular skin rash as a possible early sign of COVID-19: a case report

et al. 2020

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Background Several recent studies suggest the possibility of a skin rash being a clinical presentation of coronavirus disease 2019 (COVID-19). The purpose of this case report is to bring attention to skin manifestations in the early stage of COVID-19 in order to support frontline physicians in their crucial activity of case identification. Case presentation The patient is an Italian 32-year-old female nurse who had several close contacts with multiple patients with COVID-19 as part of her professional workload. On March 13, 2020, the patient developed an itchy, erythematous papular rash (sparing only her face, scalp, and abdomen), which lasted for 10 days. The rash was accompanied by a feeling of general fatigue that gradually worsened over the following days and has continued for 5 months (until the end of July 2020). During the first week of remote assessment carried out by her general practitioner, the patient gradually developed a dry cough, intermittent fever, and diarrhoea and then had a positive test result for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Her skin manifestations disappeared completely 48 days after the onset of the disease, followed by the disappearance of the dry cough. Conclusions In light of recent studies, this case report suggests that skin manifestations, when taken into account with other situational factors (such as profession and patient history) should be taken into proper consideration by frontline physicians as possibly being caused by SARS-CoV-2. Early identification of COVID-19 is a key part of the strategy of case detection and case isolation. To enhance this activity, further research is needed to establish frequency, symptoms, signs, and pathogenesis of skin manifestations in patients with COVID-19.

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

Cited by 339 publications

References 30 publications

Dermatologic manifestations of COVID-19-associated multisystem inflammatory syndrome in children

Dermatologic manifestations of COVID-19-associated multisystem inflammatory syndrome in children

COVID-19 associated with sensorimotor polyradiculoneuropathy and skin lesions: A case report

An itchy erythematous papular skin rash as a possible early sign of COVID-19: a case report

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