Br J Dermatol. 2020 Jul;183(1):e16. doi: 10.1111/bjd.19204.
COVID-19, also called coronavirus, is an infectious disease caused by SARS-CoV-2. First identified in December 2019, in March 2020 it was announced by the World Health Organisation that COVID-19 had become a global pandemic. The disease can affect different organ systems, and early reports have suggested skin symptoms. The researchers, working with dermatologists across Spain, reviewed 375 patients with suspected, or confirmed, COVID-19, with the aim of developing a detailed classification of the different types of skin symptoms associated with COVID-19 with corresponding images. An initial 120 images were reviewed by four dermatologists, without knowing any other clinical information, and they identified patterns of symptoms associated with COVID-19. These patterns were then applied to the rest of the images and further refined. Five common skin symptoms were identified this way. These symptoms are chilblain-like lesions, outbreaks of small blisters, wheals, rashes comprised of small flat and raised red bumps, and livedo and necrosis. Livedo is a skin condition where circulation is impaired within the blood vessels of the skin, necrosis refers to the premature death of skin tissue. These symptoms are associated with different severity of COVID-19 infection, from less severe disease in the chilblain-like lesions, to most severe in patients with livedo. The researchers noted that some of the skin symptoms associated with COVID-19 are common and can have many causes, particularly wheals and rashes. As such, they may not be particularly helpful as an aide to diagnosis.