Background Descriptions of cutaneous findings associated with COVID-19 have not been consistently accompanied by histopathology or confirmatory testing for SARS-CoV-2. Objective To describe and classify the cutaneous findings with supporting histopathology of confirmed COVID-19 inpatients.Methods We included consecutive inpatients with a confirmed diagnosis of COVID-19 for whom a dermatology consult was requested. A skin biopsy was performed in all cases. Skin findings were classified as being compatible with a cutaneous manifestation of COVID-19 or as representing a distinct clinical entity.Results Twenty-eight patients were studied in whom thirty-one dermatologic diagnoses were made. Twenty-two of the dermatoses were compatible with a cutaneous manifestation of COVID-19; nine entities were not associated with infection by SARS-CoV-2. The most common COVID-19-associated pattern was an exanthematous presentation. In four patients, a new pattern was observed, characterized by discrete papules with varied histopathological findings including a case of neutrophilic eccrine hidradenitis. No cases of pernio-like lesions were identified. Skin findings not associated with COVID-19 represented 29% of diagnoses and included Malassezia folliculitis, tinea, miliaria and contact dermatitis.Limitations There is no gold-standard test to distinguish between viral exanthems and drug reactions.Conclusion A histopathological study is critical before attributing skin findings to a manifestation of COVID-19.

Figure 1 In this graphic, patients with cutaneous manifestations (blue dots) and without cutaneous manifestations (green dots) are plotted according to their prognosis using clinical and biochemical variables. The red box represents patients with a P/F ratio >200 and CRP <11 mg/dL. The grey box represents patients with a P/F ratio >200 and CRP >11 mg/dL. The black box represents patients with a P/F ratio <200 and CRP >11 mg/dL.