Classification of the cutaneous manifestations of COVID‐19: a rapid prospective nationwide consensus study in Spain with 375 cases

Summary Background The cutaneous manifestations of COVID‐19 disease are poorly characterized. Objectives To describe the cutaneous manifestations of COVID‐19 disease and to relate them to other clinical findings. Methods We carried out a nationwide case collection survey of images and clinical data....

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Vydáno v:	British journal of dermatology (1951) Ročník 183; číslo 1; s. 71 - 77
Hlavní autoři:	Galván Casas, C., Català, A., Carretero Hernández, G., Rodríguez‐Jiménez, P., Fernández‐Nieto, D., Rodríguez‐Villa Lario, A., Navarro Fernández, I., Ruiz‐Villaverde, R., Falkenhain‐López, D., Llamas Velasco, M., García‐Gavín, J., Baniandrés, O., González‐Cruz, C., Morillas‐Lahuerta, V., Cubiró, X., Figueras Nart, I., Selda‐Enriquez, G., Romaní, J., Fustà‐Novell, X., Melian‐Olivera, A., Roncero Riesco, M., Burgos‐Blasco, P., Sola Ortigosa, J., Feito Rodriguez, M., García‐Doval, I.
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	England Oxford University Press 01.07.2020 John Wiley and Sons Inc
Témata:	Adolescent Adult Aged Aged, 80 and over Betacoronavirus - pathogenicity Case reports Child Consensus Coronavirus Infections - complications Coronavirus Infections - diagnosis Coronavirus Infections - epidemiology Coronavirus Infections - virology COVID-19 Demography Dermatologists - statistics & numerical data Epidemiology Erythema Female Humans Lesions Male Middle Aged Original Pandemics Pneumonia, Viral - complications Pneumonia, Viral - diagnosis Pneumonia, Viral - epidemiology Pneumonia, Viral - virology Prognosis Prospective Studies SARS-CoV-2 Skin Diseases, Viral - classification Skin Diseases, Viral - diagnosis Skin Diseases, Viral - virology Spain - epidemiology Surveys and Questionnaires - statistics & numerical data Terminology as Topic Time Factors Young Adult Spain
ISSN:	0007-0963, 1365-2133, 1365-2133
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Shrnutí:	Summary Background The cutaneous manifestations of COVID‐19 disease are poorly characterized. Objectives To describe the cutaneous manifestations of COVID‐19 disease and to relate them to other clinical findings. Methods We carried out a nationwide case collection survey of images and clinical data. Using a consensus we described five clinical patterns. We later described the association of these patterns with patient demographics, the timing in relation to symptoms of the disease, the severity and the prognosis. Results The lesions may be classified as acral areas of erythema with vesicles or pustules (pseudo‐chilblain) (19%), other vesicular eruptions (9%), urticarial lesions (19%), maculopapular eruptions (47%) and livedo or necrosis (6%). Vesicular eruptions appear early in the course of the disease (15% before other symptoms). The pseudo‐chilblain pattern frequently appears late in the evolution of the COVID‐19 disease (59% after other symptoms), while the rest tend to appear with other symptoms of COVID‐19. The severity of COVID‐19 shows a gradient from less severe disease in acral lesions to more severe in the latter groups. The results are similar for confirmed and suspected cases, in terms of both clinical and epidemiological findings. Alternative diagnoses are discussed but seem unlikely for the most specific patterns (pseudo‐chilblain and vesicular). Conclusions We provide a description of the cutaneous manifestations associated with COVID‐19 infection. These may help clinicians approach patients with the disease and recognize cases presenting with few symptoms. What is already known about this topic? Previous descriptions of cutaneous manifestations of COVID‐19 were case reports and mostly lacked illustrations. What does this study add? We describe a large, representative sample of patients with unexplained skin manifestations and a diagnosis of COVID‐19, using a consensus method to define morphological patterns associated with COVID‐19. We describe five clinical patterns associated with different patient demographics, timing and prognosis, and provide illustrations of these patterns to allow for easy recognition. Linked Editorial: Hay et al. Br J Dermatol 2020; 183:3–4. Plain language summary available online
Bibliografie:	Plain language summary available online ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 Plain language summary available online C. Galván Casas and A. Català contributed equally as first authors. Funding sources The analysis and technical support for this study were done by the Spanish Academy of Dermatology (Research Unit). Conflicts of interest The authors declare they have no conflicts of interest.
ISSN:	0007-0963 1365-2133 1365-2133
DOI:	10.1111/bjd.19163