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Belatedly, the disproportionate impact of COVID-19 on patients of color is getting attention. By now, we've read the headlines. Black people in the United States make up about 13% of the population but account for almost three times (34%) as many deaths. This story repeats — in other countries and in other minority communities.
Early detection is critical both to initiate supportive care and to isolate affected individuals and limit spread. Skin manifestations of COVID-19, especially those that occur early in the disease (eg, vesicular eruptions) or have prognostic significance (livedo, retiform purpura, necrosis), are critical to this goal of early recognition.
In this context, a recent systematic literature review looked at all articles describing skin manifestations associated with COVID-19. The investigators identified 46 articles published between March and May 2020 which included a total of 130 clinical images.
Their findings are striking:
92% of the published images of COVID-associated skin manifestations were in Fitzpatrick skin types I-III.
Only 6% of COVID skin lesions included in the articles were in patients with skin type IV.
None showed COVID skin lesions in skin types V or VI.
Only six of the articles reported race and ethnicity demographics.
