Patients with COVID-19 may develop myriad dermatological manifestations, a new analysis of data from an international registry confirms. These manifestations include short-lived urticarial and morbilliform eruptions and longer-lasting papulosquamous eruptions, and particularly pernio, report Dr. Esther Freeman of Massachusetts General Hospital/Harvard Medical School, in Boston, and colleagues. "Our analysis revealed a previously unreported subset of patients who experience long-hauler symptoms in dermatology-dominant COVID-19, raising questions about persistent inflammation even in patients who initially experienced relatively mild COVID-19," they write in The Lancet Infectious Diseases. The international registry for COVID-19 dermatological manifestations was developed by the International League of Dermatological Societies and the American Academy of Dermatology. Between April 8 and October 8, 1,030 total cases and 331 laboratory-confirmed or suspected COVID-19 cases with dermatological manifestations were reported to the registry from 41 countries. Of these cases, 234 cases and 96 laboratory-confirmed cases included data on the type and duration of skin problem. For all cases, the median duration of skin signs was 13 days and seven days for the subset of patients with laboratory-confirmed disease. Morbilliform eruptions lasted a median of seven days and urticarial eruptions four days among patients with laboratory-confirmed COVID-19, with a maximum duration of 28 days. Papulosquamous eruptions lasted 20 days in laboratory-confirmed cases, with one case having a confirmed "long-hauler" eruption lasting 70 days. Pernio lasted a median of 15 days in patients with suspected COVID-19, and 12 days in those with laboratory-confirmed COVID. Seven (6.8%) of the 103 cases of pernio were long-haulers with pernio lasting for more than 60 days. The researchers note that one long-hauler who presented with 20 days of cough and fatigue and 13 days of pernio lesions was initially negative for COVID-19 by PCR, serum IgM and IgG. The patient seroconverted to anti-SARS-CoV-2 IgM positivity within six weeks after developing pernio, and continued to experience severe pernio and fatigue for over 133 days. Another long-hauler who developed pernio and livedo reticularis one month after exposure to a PCR-positive family member tested positive for SARS-CoV-2 serum IgG one month after onset of pernio and continued to experience pernio and livedo reticularis lesions for more than 150 days. "Since the onset of the COVID-19 pandemic, appreciation for persistent morbidity beyond the acute phase of disease has increased. To our knowledge, our data represent the largest dataset to date on persistent skin signs and symptoms of COVID-19 and the duration for several distinct skin manifestations," the authors note. —Reuters Staff Source
