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Cutaneous Manifestations in COVID-19: Report on 31 Cases from Five Countries

Efficiency, Quality, and Costs in Health Services Research Group (EFISALUD), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36213 Vigo, Spain
Dermatology Department, Hospital Vithas Ntra. Sra. de Fátima, 36206 Vigo, Spain
University Campus, University of Vigo, 36310 Vigo, Spain
Department of Internal Medicine, General Hospital, Atizapan 52975, Mexico
Dermatological Institute and Skin Surgery “Dr. Huberto Bogaert Díaz”, Santo Domingo 1090, Dominican Republic
Institute of Cutaneous Medicine, C1425 ASU Buenos Aires, Argentina
Polyclinic National Centre, Santo Domingo 11517, Dominican Republic
Oncoderm Clinic, Bangalore 560053, India
Dermatological Center Dr. Ladislao de la Pascua (CDP), Mexico City 06780, Mexico
Research Unit, Hospital Regional de Alta Especialidad de Ixtapaluca, Mexico City 56530, Mexico
Institute of Cellular and Molecular Studies—ICM, 27003 Lugo, Spain
Dermatology Department (Section Mycology) & Research Unit, General Hospital “Dr. Manuel Gea González”, Mexico City 14080, Mexico
Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 1 Chalubinskiego Street, 50-368 Wroclaw, Poland
Author to whom correspondence should be addressed.
Biology 2021, 10(1), 54;
Received: 16 December 2020 / Revised: 9 January 2021 / Accepted: 11 January 2021 / Published: 13 January 2021
(This article belongs to the Special Issue Coronavirus Disease 2019 (COVID-19))
This large international registry-based case series contributes to the emerging evidence that skin lesions are one of the important clinical manifestations of COVID-19. Distal ischemic and necrotic lesions, and livedo racemosa usually appears in severe cases and in final disease stages. Pseudochilblains are generally associated with a more benign clinical course. Cutaneous manifestations associated with COVID-19 probably reflect the activation of pathogenic pathways by the virus or a response to inflammatory processes, vascular or systemic complications, or even treatments. Clinical doctors, in general, must be familiar with the cutaneous manifestations of COVID-19 since they may be the only manifestation of the disease in some cases. Early recognition of the cutaneous manifestations of COVID-19 can enable early diagnosis, or guide prognosis and treatment.
The increasingly frequent cutaneous manifestations of coronavirus disease (COVID-19) remain to pose a problem to clinicians. Herein, we aimed to describe the clinical and pathological findings of skin lesions in patients with COVID-19. The case series, which was based on the International Dermatological Registry circulated to dermatologists worldwide, was conducted across organizations and societies belonging to five different countries. We documented 31 patients with dermatologic manifestations associated with COVID-19, including maculopapular rashes (16.10%), urticarial lesions (26.80%), pseudochilblains (22.60%), petechiae/purpura (6.50%), distal ischaemia and necrosis (6.50%), livedo racemosa (12.90%), and others (9.70%). Twenty-six cases (83.90%) were qRT-PCR-confirmed COVID-19 cases, two (6.50%) were serologically confirmed, while two others (9.7%) were suspected cases owing to previous contact with COVID-19-positive patients. Therefore, our findings indicate that a febrile rash or even a rash in an afebrile state in the early stages of the disease may be the only clinical manifestation of COVID-19. In the future, we recommend close monitoring of all patients with skin lesions not attributable to other causal factors; in the diagnostic perspective, clinicians should aim to confirm if the skin lesions are associated with COVID-19. View Full-Text
Keywords: COVID-19; skin lesions; maculopapular rash COVID-19; skin lesions; maculopapular rash
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MDPI and ACS Style

Rodriguez-Cerdeira, C.; Uribe-Camacho, B.I.; Silverio-Carrasco, L.; Méndez, W.; Mahesh, A.R.; Tejada, A.; Beirana, A.; Martinez-Herrera, E.; Alba, A.; Arenas, R.; Szepietowski, J.C. Cutaneous Manifestations in COVID-19: Report on 31 Cases from Five Countries. Biology 2021, 10, 54.

AMA Style

Rodriguez-Cerdeira C, Uribe-Camacho BI, Silverio-Carrasco L, Méndez W, Mahesh AR, Tejada A, Beirana A, Martinez-Herrera E, Alba A, Arenas R, Szepietowski JC. Cutaneous Manifestations in COVID-19: Report on 31 Cases from Five Countries. Biology. 2021; 10(1):54.

Chicago/Turabian Style

Rodriguez-Cerdeira, Carmen, Brianda I. Uribe-Camacho, Lianet Silverio-Carrasco, Wennia Méndez, Ashwini R. Mahesh, Anakaren Tejada, Angelica Beirana, Erick Martinez-Herrera, Alfonso Alba, Roberto Arenas, and Jacek C. Szepietowski. 2021. "Cutaneous Manifestations in COVID-19: Report on 31 Cases from Five Countries" Biology 10, no. 1: 54.

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