TY - JOUR
T1 - The clinical spectrum of COVID-19–associated cutaneous manifestations
T2 - An Italian multicenter study of 200 adult patients
AU - Italian Skin COVID-19 Network of the Italian Society of Dermatology and Sexually Transmitted Diseases
AU - Marzano, Angelo Valerio
AU - Genovese, Giovanni
AU - Moltrasio, Chiara
AU - Gaspari, Valeria
AU - Vezzoli, Pamela
AU - Maione, Vincenzo
AU - Misciali, Cosimo
AU - Sena, Paolo
AU - Patrizi, Annalisa
AU - Offidani, Annamaria
AU - Quaglino, Pietro
AU - Arco, Renato
AU - Caproni, Marzia
AU - Rovesti, Miriam
AU - Bordin, Giorgio
AU - Recalcati, Sebastiano
AU - Potenza, Concetta
AU - Guarneri, Claudio
AU - Fabbrocini, Gabriella
AU - Tomasini, Carlo
AU - Sorci, Mariarita
AU - Lombardo, Maurizio
AU - Gisondi, Paolo
AU - Conti, Andrea
AU - Casazza, Giovanni
AU - Peris, Ketty
AU - Calzavara-Pinton, Piergiacomo
AU - Berti, Emilio
N1 - Funding Information:
The authors would like to thank the following collaborators for their help in data collection and patient management: Carlo Alberto Maronese, Mauro Alaibac, Maria Carmela Annunziata, Alessandro Borghi, Giuseppe Argenziano, Caterina Cariti, Andrea Carugno, Annunziata Dattola, Federico Diotallevi, Maria Concetta Fargnoli, Claudio Feliciani, Astrid Lappi, Ylenia Natalini, Mauro Panigada, Manuela Papini, Pietro Rubegni, and Marina Venturini.
Publisher Copyright:
© 2021 American Academy of Dermatology, Inc.
PY - 2021
Y1 - 2021
N2 - Background: COVID-19 is associated with a wide range of skin manifestations. Objective: To describe the clinical characteristics of COVID-19–associated skin manifestations and explore the relationships among the 6 main cutaneous phenotypes and systemic findings. Methods: Twenty-one Italian Dermatology Units were asked to collect the demographic, clinical, and histopathologic data of 200 patients with COVID-19–associated skin manifestations. The severity of COVID-19 was classified as asymptomatic, mild, moderate, or severe. Results: A chilblain-like acral pattern was significantly associated with a younger age (P <.0001) and, after adjusting for age, significantly associated with less severe COVID-19 (P =.0009). However, the median duration of chilblain-like lesions was significantly longer than that of the other cutaneous manifestations taken together (P <.0001). Patients with moderate/severe COVID-19 were more represented than those with asymptomatic/mild COVID-19 among the patients with cutaneous manifestations other than chilblain-like lesions, but only the confluent erythematous/maculo-papular/morbilliform phenotype was significantly associated with more severe COVID-19 (P =.015), and this significance disappeared after adjustment for age. Limitations: Laboratory confirmation of COVID-19 was not possible in all cases. Conclusions: After adjustment for age, there was no clear-cut spectrum of COVID-19 severity in patients with COVID-19–related skin manifestations, although chilblain-like acral lesions were more frequent in younger patients with asymptomatic/pauci-symptomatic COVID-19.
AB - Background: COVID-19 is associated with a wide range of skin manifestations. Objective: To describe the clinical characteristics of COVID-19–associated skin manifestations and explore the relationships among the 6 main cutaneous phenotypes and systemic findings. Methods: Twenty-one Italian Dermatology Units were asked to collect the demographic, clinical, and histopathologic data of 200 patients with COVID-19–associated skin manifestations. The severity of COVID-19 was classified as asymptomatic, mild, moderate, or severe. Results: A chilblain-like acral pattern was significantly associated with a younger age (P <.0001) and, after adjusting for age, significantly associated with less severe COVID-19 (P =.0009). However, the median duration of chilblain-like lesions was significantly longer than that of the other cutaneous manifestations taken together (P <.0001). Patients with moderate/severe COVID-19 were more represented than those with asymptomatic/mild COVID-19 among the patients with cutaneous manifestations other than chilblain-like lesions, but only the confluent erythematous/maculo-papular/morbilliform phenotype was significantly associated with more severe COVID-19 (P =.015), and this significance disappeared after adjustment for age. Limitations: Laboratory confirmation of COVID-19 was not possible in all cases. Conclusions: After adjustment for age, there was no clear-cut spectrum of COVID-19 severity in patients with COVID-19–related skin manifestations, although chilblain-like acral lesions were more frequent in younger patients with asymptomatic/pauci-symptomatic COVID-19.
KW - coronavirus
KW - COVID-19
KW - infection
KW - SARS-CoV-2
KW - skin manifestations
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UR - http://www.scopus.com/inward/citedby.url?scp=85102471140&partnerID=8YFLogxK
U2 - 10.1016/j.jaad.2021.01.023
DO - 10.1016/j.jaad.2021.01.023
M3 - Article
C2 - 33476725
AN - SCOPUS:85102471140
JO - Journal of the American Academy of Dermatology
JF - Journal of the American Academy of Dermatology
SN - 0190-9622
ER -