441 Cutaneous findings in COVID-19 patients hospitalized at a large urban academic medical center

Background: Cutaneous manifestations have been associated with COVID-19 infection and their clinical significance in hospitalized patients remains unclear. Methods: A retrospective chart review of 1216 patients older than 18 years of age hospitalized with laboratory-confirmed SARS-CoV-2 infection from March 12, 2020 to May 31, 2020 at a large urban academic medical center. A keyword search query of patient records combined with manual chart review by at least two dermatologists identified a study group having cutaneous manifestations concurrent with COVID-19 infection, specifically between 14 days prior to admission and up to discharge. Results: 122 patients with 195 skin lesions concurrent with COVID-19 hospitalization were identified. Dermatology reviewers evaluated clinical photographs for 116 lesions (59.5%) and inpatient dermatology consultations for 42 lesions (21.5%). The most common cutaneous findings in patients with COVID-19 hospitalization were pressure injuries (n=118;60.5%) and morbilliform eruptions (n=33;16.9%). A very small number of patients (0.6%;n=7/1216) had exanthems occurring within 2 weeks of COVID-19 symptom onset. The majority of exanthems developed within 14 days of exposure to possible culprit drugs and beyond the 14-day window of COVID-19 symptom onset, making viral association unlikely. Conclusion: Skin lesions concurrent with COVID-19 hospitalization were most frequently linked to hospitalization-related factors, such as pressure injuries or drug-related exanthems, rather than due to novel pathologies related to SARS-CoV-2 itself.