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

Adult Age of Onset Aged COVID-19 / diagnosis Chilblains / virology Humans Italy Male Middle Aged SARS-CoV-2 Severity of Illness Index Skin Diseases, Viral / diagnosis
COVID-19 SARS-CoV-2 coronavirus infection skin manifestations

Journal

Journal of the American Academy of Dermatology
ISSN: 1097-6787
Titre abrégé: J Am Acad Dermatol
Pays: United States
ID NLM: 7907132

Informations de publication

Date de publication:
05 2021
Historique:
received: 13 07 2020
revised: 10 12 2020
accepted: 06 01 2021
pubmed: 22 1 2021
medline: 27 4 2021
entrez: 21 1 2021
Statut: ppublish

Résumé

COVID-19 is associated with a wide range of skin manifestations. To describe the clinical characteristics of COVID-19-associated skin manifestations and explore the relationships among the 6 main cutaneous phenotypes and systemic findings. 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. 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. Laboratory confirmation of COVID-19 was not possible in all cases. 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.

Sections du résumé

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.

Identifiants

DOI: 10.1016/j.jaad.2021.01.023 PMID: 33476725 PMC: PMC7816892
pubmed: 33476725
pii: S0190-9622(21)00166-3
doi: 10.1016/j.jaad.2021.01.023
pmc: PMC7816892
pii:
doi:

Types de publication

Journal Article Multicenter Study

Langues

eng

Sous-ensembles de citation

IM

Pagination

1356-1363

Informations de copyright

Copyright © 2021 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Conflicts of interest None disclosed.

Auteurs

Angelo Valerio Marzano (AV)

Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy. Electronic address: angelo.marzano@unimi.it.

Giovanni Genovese (G)

Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.

Chiara Moltrasio (C)

Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, Italy.

Valeria Gaspari (V)

Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.

Pamela Vezzoli (P)

Dermatology Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy.

Vincenzo Maione (V)

Department of Dermatology, Spedali Civili, Brescia, Italy.

Cosimo Misciali (C)

Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.

Paolo Sena (P)

Dermatology Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy.

Annalisa Patrizi (A)

Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.

Annamaria Offidani (A)

Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy.

Pietro Quaglino (P)

Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy.

Renato Arco (R)

Statistician, Italian Ministry of Universities and Research, Milan, Italy.

Marzia Caproni (M)

Division of Dermatology, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy.

Miriam Rovesti (M)

Section of Dermatology, Department of Medicine and Surgery, University of Parma, Parma, Italy.

Giorgio Bordin (G)

Internal Medicine, Piccole Figlie Hospital, Parma, Italy.

Sebastiano Recalcati (S)

Dermatology Unit, ASTT Lecco, Alessandro Manzoni Hospital, Lecco, Italy.

Concetta Potenza (C)

D. Innocenzi Dermatology Unit, Sapienza University of Rome, Polo Pontino, Rome, Italy.

Claudio Guarneri (C)

Department of Dermatology, University of Messina, Messina, Italy.

Gabriella Fabbrocini (G)

Section of Dermatology, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy.

Carlo Tomasini (C)

Institute of Dermatology, Department of Clinical-Surgical, Diagnostic, and Pediatric Science, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.

Mariarita Sorci (M)

Dermatology Unit, Department of Surgery, Infermi Hospital Rimini, AUSL Romagna, Rimini, Italy.

Maurizio Lombardo (M)

Dermatology Department, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.

Paolo Gisondi (P)

Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy.

Andrea Conti (A)

Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine, Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy.

Giovanni Casazza (G)

L. Sacco Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, Italy.

Ketty Peris (K)

Institute of Dermatology, Catholic University of Rome, Rome, Italy; Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.

Piergiacomo Calzavara-Pinton (P)

Department of Dermatology, Spedali Civili, Brescia, Italy.

Emilio Berti (E)

Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › The clinical spectrum of COVID-19-associated...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Facteurs épidémiologiques › Facteurs âges › Âge de début › The clinical spectrum of COVID-19-associated...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › The clinical spectrum of COVID-19-associated...
questionsmedicales.fr › Maladies de l'appareil respiratoire › Infections de l'appareil respiratoire › Pneumopathie infectieuse › Pneumopathie virale › COVID-19 › The clinical spectrum of COVID-19-associated...
questionsmedicales.fr › Plaies et blessures › Engelure › Érythème pernio › The clinical spectrum of COVID-19-associated...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › The clinical spectrum of COVID-19-associated...
questionsmedicales.fr › Régions géographiques › Europe › Italie › The clinical spectrum of COVID-19-associated...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › The clinical spectrum of COVID-19-associated...
questionsmedicales.fr › Virus › Virus à ARN › Virus à ARN à brin positif › Nidovirales › Coronaviridae › Coronavirus › Betacoronavirus › Virus du SRAS › SARS-CoV-2 › The clinical spectrum of COVID-19-associated...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Enquêtes et questionnaires › Enquêtes de santé › Indicateurs d'état de santé › Acuité des besoins du patient › Indice de gravité de la maladie › The clinical spectrum of COVID-19-associated...
questionsmedicales.fr › Maladies de la peau et du tissu conjonctif › Maladies de la peau › Infections de la peau › Dermatoses virales › The clinical spectrum of COVID-19-associated...