The BAD is partnering with Dr Emma Craythorne and Dr Cristina Psomadakis at GSTT to collate information about cutaneous signs or complications potentially associated with Covid-19, both in adults and children.
Please complete this survey if you have encountered a patient with confirmed or suspected Covid-19 who has also displayed a new-onset rash or skin symptoms NOT attributable to a pre-existing or known skin disease or other viral disease.
We will be sharing anonymised data as required with government agencies dealing with the pandemic, and data may be published.

Data provided can be retrospective if you have already seen relevant patients.

Please complete one survey per patient.

Photos are not required; however if you have photos you are able to share, please email c.psomadakis@nhs.net for a consent form and details on how to securely send the images. 

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* 1. Patient's age, if known:

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* 2. Patient's sex:

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* 3. Patient's ethnicity

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* 4. Was the patient's Covid-19 status suspected or confirmed?

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* 5. Please provide the timeline for the skin signs appearing, in relation to the Covid-19 symptoms:

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* 6. Severity of the patient's Covid-19 - where was the patient treated?:

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* 7. Cutaneous signs, and their distribution and symmetry (select all that apply):

  Hands Feet Head / neck Lower leg Upper leg / buttocks Chest / stomach Back / shoulders SYMMETRICAL? UNILATERAL?
Acral areas of erythema-oedema with some vesicles or pustules (pseudo-chilblain)
Other vesicular eruptions
Urticarial lesions
Other maculopapules
Livedo
Necrosis

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* 8. Please list any known co-infections (excluding Covid-19) the patient was experiencing at the time of the new cutaneous signs:

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* 9. Please list any pre-existing skin diseases, if known:

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* 10. Please list any other comorbidities, if known:

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* 11. Likely aetiology of the rash / skin symptoms?

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* 12. Are you aware of any relevant investigations into these cutaneous signs, such as biopsy, blood tests or imaging? 

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* 13. Dermatology treatment / treatment for cutaneous signs:

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* 14. Resolution / outcome:

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* 15. Medical specialty of reporter:

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* 16. Location / hospital where patient seen:

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* 17. If you are happy for us to contact you with any follow-up queries, please provide your details below:

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* 18. Are you providing us with photos?