Much to be learned about COVID-19 and the skin

The global COVID-19 Dermatology Registry is collecting data on skin manifestations of COVID-19. The latest analysis of 900 cases from 39 countries presented insights with a focus on symptom duration including in long-term COVID-19 patients.

Launched in April 2020, the COVID-19 Dermatology Registry was developed and supported by the American Academy of Dermatology and the International League of Dermatological Societies to track skin manifestations of COVID-19 [1,2]. It is important to consider what the registry with a global reach can and cannot do. Prof. Esther Freeman (Director of the COVID-19 Dermatology Registry; Harvard Medical School, USA) explained, “The registry allows us to bring together the different skin manifestations that as single observations may not mean that much, but when you bring them together, they start to tell a story and will allow us to form hypotheses about how COVID-19 is presenting in the skin.” She also suggested that the registry should be seen as a giant series of case studies rather than a population-based cohort study that could tell anything about, for example, incident rates of dermatologic COVID-19 manifestations or causations.

The presented analysis was done in August 2020 when the registry already comprised 900 cases from 39 countries, of which 330 were lab-confirmed by PCR or antibody testing [1]. The providers were contacted for follow-up data and this led to 224 cases with dermatologic symptom duration data. The aim of this analysis was to shed light on the existence and duration of long-term COVID-19 symptoms of the skin. “This is particularly relevant because cutaneous manifestations are visible to the naked eye, so they are for all to see and cutaneous manifestations could be a sign of underlying pathophysiology or underlying larger-scale inflammation of the body,” said Prof. Freeman.

In terms of duration, the dermatologic symptoms lasted a median time of 12 days, but differences were observed according to the type of morphology. For example, urticaria, as may be expected, had a median duration of 5 days and papulosquamous disorders lasted a median of 20 days. Furthermore, Prof. Freeman stressed that it was also interesting to look at the outliers and 5 of those outliers with pernio qualified as “long haulers” because their symptoms lasted ≥60 days. Prof. Freeman remarked that she suspects patients with long-term COVID-19 are underrepresented in the registry. She presented an example of a patient with a dramatic clinical course of COVID toes, starting with a subtle erythema a week after the onset of cough and fatigue that worsened over time to a state with some toes being persistently violaceous and symptomatic even after over 133 days. Interestingly, the IgA levels of this patient were more in line with those seen in more severe cases with systemic symptoms than with those with short-term pernio.

“We encourage dermatologists caring for patients with long-hauler symtoms or long-term COVID-19 to enter their data in the registry so that we can better capture this population,” said Prof Freeman and asked them to submit their data under www.aad.org/covidregistry, as there is still much to study about COVID-19.

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   1. Freeman E. COVID-19 "long-haulers" in Dermatology? Duration of dermatologic symptoms in an international registry from 39 countries. D1T03.3D, EADV 2020 Virtual Congress, 29-31 Oct.
   2. Freeman E, et al. J Am Acad Dermatol. 2020;83:1118-1129.

Posted on 17 December 20205 August 2021