key: cord-1009043-p6o7s9cs authors: Freeman, E. E.; McMahon, D. E.; Lipoff, J. B.; Rosenbach, M.; Kovarik, C.; Desai, S. R.; Harp, J.; Takeshita, J.; French, L. E.; Lim, H. W.; Thiers, B. H.; Hruza, G. J.; Fox, L. P. title: The spectrum of COVID-19-associated dermatologic manifestations: an international registry of 716 patients from 31 countries date: 2020-05-25 journal: nan DOI: 10.1101/2020.05.24.20111914 sha: f8b1c777325791fdadff1668bf977dd1306aabf3 doc_id: 1009043 cord_uid: p6o7s9cs Question: What are the cutaneous manifestations associated with COVID-19 and do they provide insight into the pathophysiology or prognosis? Findings: In this international registry-based case series of 716 patients representing 31 countries, the most common dermatologic morphologies encountered in the 171 COVID-19 confirmed case included morbilliform, pernio-like, urticarial, macular erythema, vesicular, papulosquamous, and retiform purpura. Retiform purpura was seen exclusively in critically ill, hospitalized patients. Meaning: COVID-19 is associated with a spectrum of skin findings in affected patients. These cutaneous manifestations may vary depending on the severity of COVID-19. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 25, 2020. . https://doi.org/10.1101/2020.05.24.20111914 doi: medRxiv preprint Question: What are the cutaneous manifestations associated with COVID-19 and do they provide insight into the pathophysiology or prognosis? Findings: In this international registry-based case series of 716 patients representing 31 countries, the most common dermatologic morphologies encountered in the 171 COVID-19 confirmed case included morbilliform, pernio-like, urticarial, macular erythema, vesicular, papulosquamous, and retiform purpura. Retiform purpura was seen exclusively in critically ill, hospitalized patients. Meaning: COVID-19 is associated with a spectrum of skin findings in affected patients. These cutaneous manifestations may vary depending on the severity of COVID-19. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 25, 2020. 12 and retiform purpura 13 have been reported less frequently. The timing of these varied eruptions in the disease course remains unclear, as do any potential associations between morphological subtypes with different COVID-19-associated syndromes, disease courses, and/or outcomes. Of the 171 patients in the registry with laboratory-confirmed COVID-19, the most common cutaneous morphologies, in order of frequency, were morbilliform, pernio-like, urticarial, macular erythema, vesicular, papulosquamous, and retiform purpura. In general, lesions tended to occur after (64%) or concurrently (15%) with other COVID-19 symptoms. Retiform purpura appeared in patients with the most severe disease course, presenting exclusively in very ill, hospitalized patients. Skin biopsies were reviewed for 15 patients. This study highlights the array of cutaneous manifestations associated with COVID-19 diagnoses. Many morphologies were non-specific, while others may allow insight into potential immune or inflammatory pathways in COVID-19 pathophysiology. These cutaneous manifestations may vary depending on the severity of COVID-19, with retiform purpura exclusively reported in hospitalized patients. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 25, 2020. . https://doi.org/10.1101/2020.05.24.20111914 doi: medRxiv preprint Cutaneous Manifestations of COVID-19: A Preliminary Review Characterization of acute acro-ischemic lesions in non-hospitalized patients: a case series of 132 patients during the COVID-19 outbreak Chilblain-like lesions during COVID-19 epidemic: a preliminary study on 63 patients Acral cutaneous lesions in the Time of COVID-19 Vascular skin symptoms in COVID-19: a french observational study Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases Cutaneous manifestations in COVID-19: a first perspective Chilblains are a common cutaneous finding during the COVID-19 pandemic: a retrospective nationwide study from France Varicella-like exanthem as a specific COVID-19-associated skin manifestation: multicenter case series of 22 patients Digitate Papulosquamous Eruption Associated With Severe Acute Respiratory Syndrome Coronavirus 2 Infection Petechial Skin Rash Associated With Severe Acute Respiratory Syndrome Coronavirus 2 Infection Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: A report of five cases International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity We appreciate all the healthcare providers worldwide who entered cases in this registry. More detailed acknowledgements will appear in the published version of this paper.. CC-BY-NC-ND 4.0 International license It is made available under a The copyright holder for this preprint this version posted May 25, 2020. . https://doi.org/10.1101/2020.05.24.20111914 doi: medRxiv preprint