{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T08:25:18Z","timestamp":1770279918878,"version":"3.49.0"},"reference-count":33,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2020,10,12]],"date-time":"2020-10-12T00:00:00Z","timestamp":1602460800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Data on the clinical patterns and histopathology of SARS-CoV-2 related skin lesions, as well as on their relationship with the severity of COVID-19 are limited. Methods and Materials: Retrospective analysis of a prospectively collected cohort of patients with SARS-CoV-2 infection in a teaching hospital in Barcelona, Spain, from 1 April to 1 May 2020. Clinical, microbiological and therapeutic characteristics, clinicopathological patterns of skin lesions, and direct immunofluorescence and immunohistochemical findings in skin biopsies were analyzed. Results: Fifty-eight out of the 2761 patients (2.1%) either consulting to the emergency room or admitted to the hospital for COVID-19 suspicion during the study period presented COVID-19 related skin lesions. Cutaneous lesions could be categorized into six patterns represented by the acronym \u201cGROUCH\u201d: Generalized maculo-papular (20.7%), Grover\u2019s disease and other papulo-vesicular eruptions (13.8%), livedo Reticularis (6.9%), Other eruptions (22.4%), Urticarial (6.9%), and CHilblain-like (29.3%). Skin biopsies were performed in 72.4%, including direct immunofluorescence in 71.4% and immunohistochemistry in 28.6%. Patients with chilblain-like lesions exhibited a characteristic histology and were significantly younger and presented lower rates of systemic symptoms, radiological lung infiltrates and analytical abnormalities, and hospital and ICU admission compared to the rest of patients. Conclusion: Cutaneous lesions in patients with COVID-19 appear to be relatively rare and varied. Patients with chilblain-like lesions have a characteristic clinicopathological pattern and a less severe presentation of COVID-19.<\/jats:p>","DOI":"10.3390\/jcm9103261","type":"journal-article","created":{"date-parts":[[2020,10,17]],"date-time":"2020-10-17T05:45:51Z","timestamp":1602913551000},"page":"3261","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":36,"title":["Skin Manifestations in COVID-19: Prevalence and Relationship with Disease Severity"],"prefix":"10.3390","volume":"9","author":[{"given":"Priscila","family":"Giavedoni","sequence":"first","affiliation":[{"name":"Dermatology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona 08036, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4150-0522","authenticated-orcid":false,"given":"Sebasti\u00e1n","family":"Podlipnik","sequence":"additional","affiliation":[{"name":"Dermatology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona 08036, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan M.","family":"Peric\u00e0s","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona 08036, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9314-1843","authenticated-orcid":false,"given":"Irene","family":"Fuertes de Vega","sequence":"additional","affiliation":[{"name":"Dermatology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona 08036, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4156-1587","authenticated-orcid":false,"given":"Adriana","family":"Garc\u00eda-Herrera","sequence":"additional","affiliation":[{"name":"Pathology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona 08036, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3460-0384","authenticated-orcid":false,"given":"Ll\u00facia","family":"Al\u00f3s","sequence":"additional","affiliation":[{"name":"Pathology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona 08036, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1608-8820","authenticated-orcid":false,"given":"Cristina","family":"Carrera","sequence":"additional","affiliation":[{"name":"Dermatology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona 08036, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristina","family":"Andreu-Febrer","sequence":"additional","affiliation":[{"name":"Dermatology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona 08036, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7526-4973","authenticated-orcid":false,"given":"Judit","family":"Sanz-Beltran","sequence":"additional","affiliation":[{"name":"Dermatology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona 08036, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5385-127X","authenticated-orcid":false,"given":"Constanza","family":"Riquelme-Mc Loughlin","sequence":"additional","affiliation":[{"name":"Dermatology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona 08036, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9265-1019","authenticated-orcid":false,"given":"Josep","family":"Riera-Monroig","sequence":"additional","affiliation":[{"name":"Dermatology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona 08036, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Combalia","sequence":"additional","affiliation":[{"name":"Dermatology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona 08036, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4809-8866","authenticated-orcid":false,"given":"Xavier","family":"Bosch-Amate","sequence":"additional","affiliation":[{"name":"Dermatology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona 08036, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Morgado-Carrasco","sequence":"additional","affiliation":[{"name":"Dermatology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona 08036, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ramon","family":"Pigem","sequence":"additional","affiliation":[{"name":"Dermatology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona 08036, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Agust\u00ed","family":"Toll-Abell\u00f3","sequence":"additional","affiliation":[{"name":"Dermatology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona 08036, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ignasi","family":"Mart\u00ed-Mart\u00ed","sequence":"additional","affiliation":[{"name":"Dermatology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona 08036, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Rizo-Potau","sequence":"additional","affiliation":[{"name":"Dermatology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona 08036, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1231-4651","authenticated-orcid":false,"given":"Laura","family":"Serra-Garc\u00eda","sequence":"additional","affiliation":[{"name":"Dermatology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona 08036, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6018-9680","authenticated-orcid":false,"given":"Francesc","family":"Alamon-Reig","sequence":"additional","affiliation":[{"name":"Dermatology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona 08036, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pilar","family":"Iranzo","sequence":"additional","affiliation":[{"name":"Dermatology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona 08036, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4643-4456","authenticated-orcid":false,"given":"Alex","family":"Almuedo-Riera","sequence":"additional","affiliation":[{"name":"International Health Department ISGlobal, Hospital Clinic, University of Barcelona; Barcelona 08036, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jose","family":"Mu\u00f1oz","sequence":"additional","affiliation":[{"name":"International Health Department ISGlobal, Hospital Clinic, University of Barcelona; Barcelona 08036, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susana","family":"Puig","sequence":"additional","affiliation":[{"name":"Dermatology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona 08036, Spain"},{"name":"CIBER de Enfermedades Raras, Instituto de Salud Carlos III, Barcelona 08036, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"Jr.","given":"Jos\u00e9 M.","family":"Mascar\u00f3","sequence":"additional","affiliation":[{"name":"Dermatology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona 08036, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2020,10,12]]},"reference":[{"key":"ref_1","unstructured":"(2020, May 03). 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