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An update on cutaneous manifestations of COVID-19

Dermatologist around the globe have mobilized and are actively collecting data on how the novel virus attacks the skin.   Like many other systemic conditions, skin findings can be an important clue to diagnosis as well as a sign that could portend the beginning of more serious progression as well as certain manifestation that could herald a more benign course.  

In the early stages of COVID, the primary concern was the effect the virus had on the pulmonary system.  Sick patients who were coming into the ER were not given skin exams.  As the crisis evolves, we are understanding the potential damage the virus can do to many organ systems.

Part of the information gathering is done by an international registry in which dermatologist participate.  When a dermatologist sees a patient with either suspected or confirmed COVID-19 and has skin findings, the information is entered into the registry.  Data is carefully reviewed and correlated with academic centers to ascertain trends. 

One of the ways that this virus acts is to affect the inner lining of blood vessels and cause damage. A related skin finding has been called “COVID toes” which most closely resembles Pernio.  Pernio, or Chilblains, is an uncommon condition that typically affects children or the elderly. Temperature changes causes the tiny vessels of the distal extremities to restrict, resulting in blisters or red to purple sores. 

An academic dermatology center in New York city reported that they would typically see 1-2 cases of Pernio a year; however, during the current COVID-19 crisis, they are seeing 5-10 cases a day.  

Other rashes that have been associated with COVID-19 infection include livedo, urticaria (hives), a sunburn like redness as well as rashes that can resemble measles and chickenpox.  The development of a new rash, especially when associated with other signs such as fever, cough, and respiratory symptoms are reason for further evaluation.