The clinical spectrum of COVID-19–associated cutaneous manifestations: An Italian multicenter study of 200 adult patients

Italian Skin COVID-19 Network of the Italian Society of Dermatology and Sexually Transmitted Diseases, A.V. Marzano, G. Genovese, C. Moltrasio, V. Gaspari, P. Vezzoli, V. Maione, C. Misciali, P. Sena, A. Patrizi, A. Offidani, P. Quaglino, R. Arco, M. Caproni, M. Rovesti, G. Bordin, S. Recalcati, C. Potenza, C. Guarneri, G. FabbrociniC. Tomasini, M. Sorci, M. Lombardo, P. Gisondi, A. Conti, G. Casazza, K. Peris, P. Calzavara-Pinton, E. Berti

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)1356-1363
Number of pages8
JournalJournal of the American Academy of Dermatology
Issue number5
Publication statusPublished - 2021


  • coronavirus
  • COVID-19
  • infection
  • SARS-CoV-2
  • skin manifestations
  • adult
  • age
  • aged
  • Article
  • chilblain
  • clinical feature
  • coronavirus disease 2019
  • demography
  • disease association
  • disease duration
  • disease severity
  • female
  • histopathology
  • human
  • livedo reticularis
  • maculopapular rash
  • major clinical study
  • male
  • measles like rash
  • multicenter study
  • phenotype
  • priority journal
  • risk factor
  • skin manifestation
  • clinical trial
  • Italy
  • middle aged
  • onset age
  • pathology
  • severity of illness index
  • viral skin disease
  • virology
  • Adult
  • Age of Onset
  • Aged
  • Chilblains
  • Humans
  • Male
  • Middle Aged
  • Severity of Illness Index
  • Skin Diseases, Viral


Dive into the research topics of 'The clinical spectrum of COVID-19–associated cutaneous manifestations: An Italian multicenter study of 200 adult patients'. Together they form a unique fingerprint.

Cite this