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

J Am Acad Dermatol. 2020 Oct;83(4):1118-1129. doi: 10.1016/j.jaad.2020.06.1016. Epub 2020 Jul 2.


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.

Keywords: COVID toes; COVID-19; SARS-CoV-2; dermatology; global health; macular erythema; morbilliform; pernio; public health; registry; retiform purpura; urticarial; vesicular.

MeSH terms

  • Adolescent
  • Adult
  • Betacoronavirus / immunology*
  • Betacoronavirus / isolation & purification
  • COVID-19
  • Coronavirus Infections / complications*
  • Coronavirus Infections / diagnosis
  • Coronavirus Infections / immunology
  • Coronavirus Infections / virology
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Pandemics
  • Pneumonia, Viral / complications*
  • Pneumonia, Viral / diagnosis
  • Pneumonia, Viral / immunology
  • Pneumonia, Viral / virology
  • Registries / statistics & numerical data*
  • SARS-CoV-2
  • Severity of Illness Index
  • Skin Diseases / diagnosis
  • Skin Diseases / epidemiology
  • Skin Diseases / immunology*
  • Skin Diseases / virology
  • Young Adult