Prevalence of COVID-19-Related Cutaneous Manifestations is Lower in Skin of Color

Young ill woman wearing a purple face mask, coughing, resting on the couch covered with a blanket.
The prevalence and patterns of cutaneous manifestations in COVID-19 in patients with skin of color is reported.

The prevalence of cutaneous manifestations related to coronavirus disease 2019 (COVID-19) is reportedly lower in people with skin of color compared with people with lighter skin phototypes, according to findings from a small study published in Clinical and Experimental Dermatology.

The study included 10 patients with cutaneous manifestations who were admitted to an inpatient department at a center in India dedicated for COVID-19-positive patients. Patients were admitted to the department from June 11 to July 10, 2020.

The major criteria used to distinguish COVID-19-related cutaneous manifestations from unrelated or incidental skin findings included the temporal correlation with the onset of COVID-19 symptoms or positivity. Minor criteria included resemblance to the already-reported COVID-19-related cutaneous features and no other plausible explanation for the lesions.

Patients included in the analysis had skin Fitzpatrick phototypes 4 and 5. The cutaneous features all followed symptoms of COVID-19. The researchers noted that the prevalence of cutaneous manifestations in their patients with COVID-19 was 7.25%, compared with 0.2% in a Chinese study and 20.4% in an Italian study.

The researchers point out that India has a low case fatality rate for COVID-19 compared with other areas of the world. In terms of the lower prevalence of cutaneous manifestations in Asian populations, the researchers explain that differences in thrombophilic genetic conditions across regions may explain more frequent cutaneous manifestations as well as fatalities in places like the United States and Europe.

Limitations of this study included the small sample size as well as the inclusion of patients from a single center in India, which may reduce the generalizability of the findings.

The researchers concluded that the recognition of skin features in patients with darker skin phototypes “is important for dermatologists as these may appear before the systemic symptoms or before SARS CoV-2 positivity is established or maybe the sole manifestations in systematically asymptomatic patients.”


Pangti R, Gupta S, Nischal N, Trikha A. Recognizable vascular skin manifestations of SARS-CoV-2 (COVID-19) infection are uncommon in patients with darker skin phototypes. Clin Exp Dermatol. 2021;46(1):180-182. doi:10.1111/ced.14421