Skin manifestations of Covid-19

S Khan, G Wali, J Reed

Vesicular eruption* (9%)

• Early presentation (15% before other symptoms)
• Monomorphic versus polymorphic vesicles in chickenpox • Herpes zoster more common
• May have haemorrhagic component • Mean duration 10.4 days
• Itchy (68%) • Associated with intermediate severity of Covid-19 infection

Pseudovesicular

Monomorphic Erythema
disseminated Multiforme
vesicles like

Livedo or necrosis (6%) Urticarial lesions (19%)

• Trunk or acral • Appear at same time as other symptoms
• Older • Mostly trunk, few cases palmar
• Associated with more severe Covid- • Itchy (92%)
19 infection (mortality 10%) • Mean duration 6.8 days
5 • Associated with more severe Covid-19
infection

Clinical Patterns
*most specific

Maculopapular eruption (47%) Pseudo-chilblain* (19%)

• Appear at same time as other symptoms • Late presentation (59% after other
• Perifollicular symptoms)
• Can be similar to pityriasis rosea • Acral sites
• Purpura may be present (punctiform or on • Usually asymmetric
large areas) • Younger
• Infiltrated papules, often dorsum hands, • Mean duration 12.7 days
resembling erythema elevatum diutinum or • Associated with less severe Covid-19
erythema multiforme infection
• Itchy (57%)
• Mean duration 8.6 days
• Associated with more severe Covid-19
Pseudo-chilblain
infection

If you are reviewing a patient with any of these signs:

• Ensure you are wearing adequate PPE (Level 1: surgical mask, apron, gloves)
• If you are examining the mouth, you must wear eye protection as there is a risk of spray
• If outpatient testing is available, arrange for patient to be tested for Covid-19, otherwise advise isolation as per
government advice: https://www.gov.uk/government/publications/covid-19-stay-at-home-guidance/stay-at-home-
guidance-for-households-with-possible-coronavirus-covid-19-infection
• Record the patient’s MRN number in the excel spreadsheet in the Covid-19 folder on Dermdata entitled: Skin
manifestations in Covid-19- OUH data
Casas CG, Català. A et al. Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases. British Journal of Dermatology. 2020 April 29 2020. doi:10.1111/bjd.19163. [Epub ahead of print].1