Until now, the skin manifestations caused by the new coronavirus have gone unnoticed. However, recently, a work published in the British Journal of Dermatology, and which has been supported by the Spanish Academy of Dermatology and Venereology, showed that skin lesions can be classified into five patterns associated with a specific prognosis of infection. by COVID-19.

After having collected and analyzed 375 cases – either by meeting clinical criteria or by laboratory confirmation and concomitant skin changes without a known cause – the “COVID Skin” study may already offer its conclusions. In addition to collecting information on the health status of the participants, photographs of each of the skin problems have also been taken, something that no other study so far had achieved.

Analysis and use of a consensus method have shown that five patterns of skin manifestations can be established: chilblain-like rashes in acral areas (19%); vesicular eruptions (9%); urticarial lesions (19%); maculopapuleous eruptions (47%) and livedo-reticularis or necrosis (6%).


The cutaneous manifestations of the disease have been made easier to read, thanks to the multicenter study in which almost a hundred Spanish dermatologists participated, led by Cristina Galván Casas, of the Dermatology Service of the Hospital Universitario de Móstoles in Madrid; Alba Català Gonzalo, from the Dermatology and Venereology Service of the Plató Hospital in Barcelona and Gregorio Carretero Hernández, from the Dermatology Service of the University Hospital Gran Canaria Doctor Negrín de Las Palmas de Gran Canaria.

Each of these patterns has been associated with specific patient characteristics, evolution and severity of the disease.

“What we have seen, in addition to categorizing skin manifestations into five groups, is a disease gradient, from less severe in cases where there were pseudo-chilblains to more severe in patients with livedo-reticularis lesions, who presented more cases of pneumonia, hospital admissions and need for intensive care, ”says Dr Ignacio García-Doval, director of the Research Unit of the Spanish Academy of Dermatology and Venereology (AEDV).

Each of these patterns has been associated with specific patient characteristics, evolution and severity of the disease:

Acral rashes similar to chilblains (hands and feet) appeared as erythema or violaceous areas, vesicles, and pustules. They are frequently asymmetric. This type of injury was detected in 19% of cases, in younger patients, in the late stages of the COVID-19 process, lasting 12.7 days and associated with a less severe prognosis.

Vesicular eruptions, detected in 9% of cases, have been seen mainly on the trunk. They consisted of small monomorphic vesicles (lesions very similar to each other) unlike those that appear in chickenpox that are polymorphic. Sometimes they settled on the extremities and could have hemorrhagic content, enlarge or spread. The study has shown that this type of manifestation is associated with intermediate severity and is more frequent in middle-aged patients. They usually last for about ten days and appear along with general symptoms, sometimes before them.

Urticarial lesions, the third type of pattern, have been recorded in 19% of cases, they have been seen mainly on the trunk or scattered throughout the body, in some cases on the palms of the hands. Its average duration is 6.8 days. They usually produce intense itching. This type of manifestation has been observed in more severe patients and has appeared more frequently at the same time as other symptoms related to COVID-19.

Maculopapules, the most frequent manifestations, were detected in 47% of cases, the dermatological picture is frequently similar to that of other viral infections. Sometimes you show specific patterns, such as the peri-follicular distribution, or similar to pityriasis rosea or erythema multiforme. The last 8 or 9 days on average. They have also been seen in more severe patients.

Finally, injuries that lead to vascular obstruction, such as livedo-reticularis and necrosis, have been found in 6% of cases, have appeared in older and more severe patients (in this group, 10 % mortality). The patients showed different degrees of involvement, including areas of acral or trunk ischemia. However, the COVID-19 manifestations in this group were more variable, such as the case of transient reticular livedo in young patients with good evolution of the process.

Adriana Raimondi, a dermatologist doctor member of the Argentine Society of Dermatology and the American Academy of Dermatology, assures that “dermatologists have an obligation to think of COVID-19 in patients who present vascular lesions, of those categorized in this study and of asking the corresponding questions as if the patient has had a fever, cough, or loss of taste or smell ”. “Dermatological injuries come to join the group of already known symptoms,” said the specialist in dialogue with this medium.

“The work is very complete and has a review of a very high number of cases. What dermatologists know is that all viral diseases can have cutaneous manifestations. This is very varied in the presentation but we are used to seeing different types of manifestations as the study shows and the COVID-19 does not escape these characteristics, “he warned about the study.

The work is very complete and has a review of a very high number of cases. What dermatologists know is that all viral diseases can have cutaneous manifestations

For Raimondi, these are vascular-type injuries. “Often the wide range of skin manifestations can be confused with an allergic reaction in both the trunk and the limbs. However, consultation regarding these lesions is particularly important because infected patients are sometimes asymptomatic and could be a single manifestation or one that alerts to the diagnosis, “he concluded.

“The Spanish research allows us to see the dermatological manifestations from least to most serious. The patients with livedo reticularis or necrosis were patients who received intensive therapy, pneumonia and a very poor prognosis, ”Claudia Sánchez, a dermatologist at Halitus Instituto Médico, explained in dialogue with Infobae.

It should be borne in mind, clarifies the research, that it cannot be ruled out that there are other causes behind some of these skin manifestations, especially in the case of urticariform lesions or maculopapular, which could have other causes, such as reactions to any of the many drugs they have received. However, this work did not aim to know the causes behind these manifestations but to establish cutaneous semiology and analyze its diagnostic and prognostic value.