The new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pathogen and the subsequent coronavirus disease (COVID-19) mainly affect the lung.1 Respiratory symptoms are key for diagnosis, however, increasing knowledge has led to the understanding that COVID-19 induces multiorgan pathology. The first descriptions of clinical symptoms reported that 0.2% of patients admitted to hospitals in China presented with a skin rash.1 Following this, in Italy 20.4% of 88 admitted patients treated by dermatologists presented with symptoms of the skin.2 In April 2020, the first comprehensive classification of skin manifestations in patients within the full spectrum of COVID-19 severity, from intensive care, hospital wards, and home care, as well as those without symptoms, was published.3 The study analysed 375 patients with PCR-confirmed diagnosis or with suspected diagnosis, meeting the European Centre for Disease Prevention and Control (ECDC) clinical criteria. Although following certain patterns, skin manifestations showed extreme variability. Five skin patterns were defined: pseudo-chilblain, vesicular, urticarial, maculopapular, and livedo/necrosis. Each pattern usually associated with a different age category, evolutionary moment of the process, and systemic severity.3 The majority of these manifestations were non-specific and their cause–effect relationship with the virus is not fully established. The limited access to confirmatory tests and concurrence of different drugs to treat the disease make it difficult to reach any conclusions. The authors present the case of a patient in whom the most striking COVID-19 manifestation was dermatological.
