Editor’s Note: Find the latest COVID-19 news and guidance from Medscape Coronavirus Resource Center.
A small subset of SARS-CoV-2 patients with “COVID toes” can be classified as COVID long-distance infected individuals, and new analysis reveals that skin symptoms can last for more than 150 days.
Evaluating data from the international enrollment of COVID-19 patients with cutaneous symptoms, researchers found that reticular purpura rash was associated with severe COVID-19, and 100% of these patients required hospitalization, 82 Discovered that% is experiencing. Acute respiratory distress syndrome (ARDS).
On the other hand, a pernio / chilblains rash called “COVID toes” is associated with mild illness and a 16% hospitalization rate. The average duration is 12 days for all skin symptoms associated with COVID.
“Skin is another organ system that I didn’t know had a long COVID effect,” said Esther Freeman, MD, a senior researcher at Massachusetts General Hospital and Harvard Medical School in Boston.
Dr. Esther Freeman
“The fact that we were able to visually see the persistent inflammation of long-distance patients is particularly appealing because the skin is actually a window to how the body works overall. Gives you the opportunity to explore what’s happening, “Freeman said. Medscape Medical News.. “Because we know what we know about other organ systems, it certainly makes sense to me that there may also be long-term inflammation of the skin.”
This study is the result of collaboration between the American Academy of Dermatology and the International Federation of Dermatological Associations (the international registry launched this April). The study included data from 990 healthcare providers across 39 countries, but the registry now includes more than 1000 patients from 41 countries, Freeman said. I am.
Freeman presented the data at the virtual 29th European Academy of Dermatology (EADV) conference.
She said that many studies reported the effects of COVID-19 infection on the skin, but lacked information on the duration. This registry represents the largest dataset to date detailing these persistent cutaneous symptoms, and how COVID-19 is present in many different organ systems, even after the patient recovers from an acute infection. Provides insight into what will affect you.
Eight types of skin rashes were found in the study group, of which 303 were confirmed or suspected in the laboratory to be COVID-19 patients with skin symptoms. Of these, a total of 224 cases and 90 tests confirmed included information on how long the skin symptoms lasted. Lab tests for SARS-CoV-2 included PCR and serum antibody assays.
Freeman and her team defined a “long-distance carrier” as a patient with COVID-19 skin symptoms that lasted more than 60 days. These “outliers” are likely to be more common than the registry suggests, as not all providers who first reported the patient’s skin condition updated that information over time, she said. Said.
“It’s important to understand that the registry probably significantly underreports the duration of symptoms and the number of long-distance patients,” she explained. “The registry often gives a glimpse of these patient moments. To counter this, we emailed the provider twice, asking if the patient’s symptoms were still ongoing or complete.”
The results showed a broad spectrum over the mean duration of laboratory-confirmed symptoms in COVID-19 patients, depending on the particular rash. hives The median lasted 4 days. Morbilliform rash, 7 days; pernio / chilblains, 10 days; papule squamous cell rash, 20 days, 1 long-distance transporter lasted 70 days.
Five patients with chilblains / chilblains were long-distance transporters, and toe symptoms lasted for more than 60 days. Only one person had more than 133 days of severe chilblains and malaise.
“The fact that these long-distance symptoms are not always present in all types of skin rashes makes sense,” Freeman said. “For example, urticaria usually occurs rapidly and leaves fairly quickly. There are no reports of long-distance urticaria.”
“The actual presence of these long-distance symptoms in a particular skin rash really suggests that a particular pathophysiology is occurring within that group of patients,” she added.
Freeman said that sufficient data have not yet been generated to correlate long-standing COVID-19 skin symptoms with persistent heart, nerve, or other symptoms of long-term inflammation caused by the virus.
Meanwhile, an EADV survey of 490 dermatologists found that just over one-third of patients showed skin signs of COVID-19. In addition, 4% of the dermatologists themselves were virus positive.
Freeman recommended that all front-line clinicians assessing COVID-19 patients with cutaneous symptoms register the patients in the register. But despite its strengths, the registry says, “We can’t tell us what percentage of everyone who gets a COVID develops skin findings, or what percentage will have a long-distance infection.” She said.
“It’s like a huge case series because the registry doesn’t have a denominator,” she added.
“Because of the second or third wave of COVID-19 occurring in many parts of the world, we are positively tracking patients and recognizing that their symptoms last for different periods of time, and these symptoms It will be very helpful in the future to be aware that it can occur. Skin, “she said.
Dr. Christopher Griffith
Christopher Griffiths, MD of the University of Manchester, UK, praised international registration as a valuable tool to help clinicians better manage patients with COVID-related skin effects and predict prognosis.
“This brings together the international dermatology community to work on focused goals that are relevant to all of us around the world,” Griffith said. Medscape Medical News. “It shows the power of communication and collaboration and what can be achieved in a short period of time.”
Freeman and Griffith do not disclose the relevant financial relationship.
29th European Academy of Dermatology (EADV) Conference: Summary 3090, announced on October 29, 2020.
Follow Medscape on Twitter @Medscape And Maureen Salomon @maureensalamon
