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Cross-specialty collaboration key to tracking COVID-19 skin symptoms


Esther Freeman, M.D., details the team effort made by the American Academy of Dermatology’s (AAD) COVID-19 Task Force to launch an international registry documenting skin manifestations in patients diagnosed with or suspected of COVID-19 infection.

With the discovery of skin manifestations related to COVID-19, the American Academy of Dermatology’s (AAD) COVID-19 Task Force came together to develop an international registry dedicated to identifying and tracking skin symptoms associated with the disease.

In a story initially published by AAD, Esther Freeman, M.D., Ph.D., DTM&H, FAAD, principal investigator for the COVID-19 Dermatology Registry, says the purpose of the registry is to gather observations from health care providers across the globe that will help researchers identify trends and form hypotheses about the virus.

MORE: This skin lesion may signal severe disease in COVID-19 patients

Massachusetts General Hospital, the International League of Dermatological Societies and the AAD’s COVID-19 Task Force took only eight days to obtain ethical approval and launch the registry worldwide in April 2020.

“Remarkable levels of collaboration across specialties and the international health care community during these unprecedented times have been the key to the registry’s success. For me, this collaboration has been a bright spot in an otherwise dark time,” says Dr. Freeman.

The registry is open to contributions from any health care professional. Those wishing to partake can fill out a brief form regarding a patient confirmed or suspected of having COVID-19 along with noticeable skin changes. She says the registry also collects data on COVID-19 patients who have existing dermatologic conditions such as psoriasis and eczema. So far, data collected from the registry has been used in numerous articles published in the Journal of the American Academy of Dermatology (JADD).

RELATED: Skin findings in patients with suspected COVID-19

According to Dr. Freeman, within the registry’s first four months, they received more than 1,000 submissions from frontline clinicians located in 40 countries, including dermatologists, intensivists, pediatricians and podiatrists. She says nearly 50% of the submissions detailed “unusual pernio-like red or purple tender bumps on the toes and fingers,” which were referred to as “COVID toes” by the media.

“I’ve had physician colleagues from other specialties tell me they diagnosed active COVID-19 from skin findings alone based on our work. If this effort contributes to preventing even a few transmissions of the virus, I consider that an achievement,” says Dr. Freeman.

“Dr. Freeman and her colleagues quickly recognized the need to identify dermatologic manifestations of COVID-19 from the global community and assembled a registry in record time,” says Ingrid V. Bassett, M.D., MPH, Massachusetts General Hospital COVID-19 Task Force, Epidemiology/Outcomes team leader, Harvard Medical School, Division of Infectious Diseases. “Her work has advanced our understanding not only of the acute manifestations of COVID-19, but also of long-term skin findings which may give insights into the immune response to the virus. By drawing on worldwide clinical observations, Dr. Freeman’s work opens up a field of inquiry in immunology. This is an outstanding achievement.”

Clinicians wishing to submit a report to AAD’s COVID-19 Dermatology Registry can fill out the form at www.aad.org.


Creating an international dermatology COVID-19 registry. (n.d.). Retrieved September 17, 2020, from https://www.aad.org/skinserious/stories-esther-freeman

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