The American Academy of Dermatology COVID-19 registry: Crowdsourcing dermatology in the age of COVID-19

There have been increasing reports of dermatologic manifestations of COVID-19. The first case series of dermatologic manifestations included 18 Italian patients with erythematous, urticarial, and vesicular rashes, often on the trunk.¹ Other reports include drug hypersensitivity,² urticaria,² a petechial rash mimicking dengue,³ and acro-ischemia.⁴

It is important to further characterize dermatologic manifestations of COVID-19 to understand the relationship between the virus and skin and to determine whether cutaneous manifestations of COVID-19 may assist with early disease detection. To date, collecting cases of dermatologic manifestations of COVID-19 has been challenging given their relative infrequency and the rapid spread of COVID-19. Dermatologists are relying on informal networks, including social media, to share cutaneous manifestations of the disease. To rapidly and centrally collate these cases from a global network and inform colleagues on the front lines combatting the virus, the American Academy of Dermatology (AAD) COVID-19 Task Force has launched an online COVID-19 dermatology registry. This registry was inspired by a similar registry created by the COVID-19 Global Rheumatology Alliance.⁵

The registry's primary purpose is to rapidly collect COVID-19 cutaneous manifestations to enable prompt dissemination of the findings to the dermatology community and front-line health care workers. Given early reports of COVID-19 disparities across racial and socioeconomic groups in the United States, we encourage submission of COVID-19 cases across all ages, races, and socioeconomic statuses. A secondary objective is to report how COVID-19 affects patients with pre-existing dermatologic conditions, particularly those receiving immunosuppressive therapies. We expect that these results will generate ideas for further epidemiologic studies on COVID-19 in dermatology.

The registry is available online through the AAD website at www.aad.org/covidregistry. The International League of Dermatological Societies is collaborating with the AAD on this registry with the aim of extending its reach internationally. Cases can be entered by any health care worker, including nondermatologists and non–AAD members, from around the world. Data entry takes 5 to 7 minutes and requires no patient protected health information. Patient demographics, new-onset dermatologic conditions in the setting of COVID-19, dermatologic and medical history, and the patient's COVID-19 diagnosis and treatment are requested. COVID-19 diagnosis may be based on clinical suspicion alone or laboratory confirmation. The registry was reviewed by the Partners Healthcare (Massachusetts General Hospital) institutional review board. Data are housed securely through Partners REDCap, and is not housed at the AAD.

We recognize the limitations of such a registry, including selective reporting, duplicate case entries, and lack of a denominator, that preclude us from accurately estimating incidence or prevalence. This registry does not replace rigorous epidemiologic studies. However, we believe this registry will allow the global community to rapidly share observations without the institutional or national boundaries that often limit scientific collaboration.

Ultimately, the success of this international effort depends on the active participation of all health workers caring for patients with COVID-19. Together, we hope to use this registry to compile a more complete and representative case series of potential dermatologic manifestations of COVID-19 and outcomes of established dermatology patients who develop COVID-19.