New analysis reveals ‘long-hauler’ COVID-19 patients with prolonged skin symptoms

Some COVID-lasting skin symptoms that vary according to type of COVID-19 skin rash, a late-breaking abstract will reveal at the 29th EADV Congress, EADV Virtual.

Analysis of the largest registry of COVID-19 patients with dermatological symptoms has revealed a subset of patients, called "long-haulers" or "long COVID," who experience prolonged symptoms (lasting >60 days) on their skin.

Data from 990 cases from 39 countries input into the registry, a collaboration between the International League of Dermatological Societies and the American Academy of Dermatology, show an average duration of 12 days for all dermatological symptoms, with some lasting as long as >150 days.

Patients presented with a broad spectrum of dermatologic manifestations lasting for different lengths of time, including hives (urticaria), lasting for median 5 days, and pernio/chilblains (‘‘COVID toes’’), lasting 15 days but sometimes as long as 130-150 days, and papulosquamous eruptions, which are scaly papules and plaques, persisting for 20 days.

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The identification of this unique subset of “COVID toes” patients with symptoms lasting long after the acute phase of COVID-19 may have implications for understanding the prolonged inflammatory response in some patients after infection.

Skin symptoms vary by COVID-19 severity. Some symptoms, such as retiform purpura, are associated with severe COVID-19, since 100% of these patients were hospitalised, while COVID toes travel with relatively mild disease, with only 16% hospitalised. Furthermore, although COVID toes often appear 1-4 weeks after initial infection, 15% were found to still be PCR positive for COVID-19.

Dr Esther Freeman, Principal Investigator of the International COVID-19 Dermatology Registry and Director, Global Health Dermatology, Massachusetts General Hospital says, “Our registry identified a previously unreported subset of patients with longstanding skin symptoms from COVID-19. We highlight patients with pernio/chilblains, also known as COVID toes, who have had symptoms for as long as 150 days. This data adds to our knowledge about how COVID-19 can affect multiple different organ systems, even after patients have recovered from their acute infection. The skin can provide a visual window into inflammation that may be going on elsewhere in the body.”

At EADV 2020, COVID-19 is a key talking point and something that the world is learning more about every day. Dermatological symptoms of COVID-19 and the impact of COVID-19 on dermatology practitioners and patients is just beginning to be understood and is being explored at the Congress.

An EADV survey of 490 dermatologists has revealed that 35% saw patients presenting skin-signs of COVID-19 and that 4% of the dermatologists themselves tested positive for COVID-19.These findings highlight the need for further research into the dermatological symptoms of COVID-19 and the interaction between COVID and underlying skin conditions. These data also stress the importance of using protection means such as facemasks during dermatological consultations.

Finally, Dr Asja Prohic, Medical Faculty University of Sarajevo, is presenting growing research investigating the possible association between male pattern baldness (androgenetic alopecia) and men hospitalised with COVID-19.

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