The clinical spectrum of COVID-19–associated cutaneous manifestations. An Italian multicenter study of 200 adult patients

Background: COVID-19 is associated with a wide range of skin manifestations. Objective: To describe the clinical characteristics of COVID-19–associated skin manifestations and explore the relationships among the 6 main cutaneous phenotypes and systemic findings. Methods: Twenty-one Italian Dermatology Units were asked to collect the demographic, clinical, and histopathologic data of 200 patients with COVID-19–associated skin manifestations. The severity of COVID-19 was classified as asymptomatic, mild, moderate, or severe. Results: A chilblain-like acral pattern was significantly associated with a younger age (P <.0001) and, after adjusting for age, significantly associated with less severe COVID-19 (P =.0009). However, the median duration of chilblain-like lesions was significantly longer than that of the other cutaneous manifestations taken together (P <.0001). Patients with moderate/severe COVID-19 were more represented than those with asymptomatic/mild COVID-19 among the patients with cutaneous manifestations other than chilblain-like lesions, but only the confluent erythematous/maculo-papular/morbilliform phenotype was significantly associated with more severe COVID-19 (P =.015), and this significance disappeared after adjustment for age. Limitations: Laboratory confirmation of COVID-19 was not possible in all cases. Conclusions: After adjustment for age, there was no clear-cut spectrum of COVID-19 severity in patients with COVID-19–related skin manifestations, although chilblain-like acral lesions were more frequent in younger patients with asymptomatic/pauci-symptomatic COVID-19.