Cutaneous manifestations in coronavirus disease 2019 (COVID-19) patients may possess prognostic value for identifying potentially severe cases. This systematic review investigated whether dermatological features are associated with COVID-19 outcomes in elderly patients. Literature retrieval was conducted on May 11, 2022, from databases, hand-searching, and tracing citations. Following selection against eligibility criteria, the remaining records were evaluated utilizing the National Heart, Lung, and Blood Institute Study Quality Assessment Tool or Newcastle–Ottawa Scale. The pooled individual data were subsequently analyzed using the Cochran–Mantel–Haenszel test to calculate the odds ratio (ORs) and confidence intervals (CIs) for the severity and mortality of each skin lesion type. We incorporated 70 articles, including 180 and 117 entries, with information regarding disease severity and mortality. Further analysis revealed that vascular type was the skin lesion most frequently noticed in confirmed COVID-19 elderly patients (46.2%) and was associated with an increased risk of developing advanced disease (OR 7.32, 95% CI 3.39–15.81) and the ensuing termination (OR 5.73, 95% CI 2.46–13.36). The converse phenomenon was observed in maculopapular type (severity OR 0.27, 95% CI 0.14–0.52; mortality OR 0.10, 95% CI 0.03–0.36). In conclusion, skin manifestations may predict COVID-19 severity and mortality in the senior group. © 2023 Japanese Dermatological Association.