The clinical spectrum of COVID-19-associated cutaneous manifestations: an Italian multicentre 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 between the six main cutaneous phenotypes and systemic findings. Methods: Twenty-one Italian Dermatology Units were asked to collect the demographic, clinical and histopathological 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 significantly associated with a younger age (p<0.0001) and, after adjusting for age, significantly associated with less severe COVID-19 (p=0.0009). However, the median duration of chilblain-like lesions was significantly longer than that of the other cutaneous manifestations taken together (p <0.0001). 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 significantly associated with more severe COVID-19 (p=0.015), and this significance disappeared after adjusting for age. Limitations: Laboratory confirmation of COVID-19 was not possible in all cases. Conclusions: After adjusting 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/paucisymptomatic COVID-19.