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Long-Hauler Patients Show Prolonged Cutaneous Symptoms of COVID-19

Analysis from the COVID-19 Dermatology Registry revealed that some patients who develop cutaneous symptoms of the disease become “long haulers” with persistent skin symptoms lasting as long as 150 days. Data were presented in a late-breaking abstract by principal investigator Esther Freeman, MD, PhD, at EADV Virtual on October 29, 2020.1

As of August 2020, 990 cases from 39 countries were recorded, with 303 laboratory-confirmed cases of COVID-19. Of these cases, patients presented with a variety of symptoms, including pernio; vesicular, urticarial, macular erythema, and morbilliform morphologies; and retiform purpura. Previous analysis of this data showed that the rate of hospitalization varied based on COVID-19 skin symptoms; 100% of patients with retiform purpura were hospitalized vs 16% of patients with pernio.2

In the present analysis, all dermatologic symptoms of COVID-19 had an average duration of 12 days, and the laboratory-confirmed subset of cases had an average duration of 7 days.1 Manifestations such as urticaria, morbilliform, and macular erythema lasted for a median of 5 days, 7 days, and 10 days, respectively. More notably, papulosquamous eruptions lasted 20 days, with a few outlier cases lasting as long as 70 days. Pernio/chilblains lasted for a median of 15 days; however, six cases of pernio/chilblains lasted 60 days or more, with one laboratory-confirmed case persisting as long as 150 days.

“I think it’s important to note that the registry data really likely underrepresents the reality, because most of the providers did data entry at one time period very shortly after seeing the patient, and if the symptoms were ongoing, the full course may not have been captured,” said Dr Freeman in the presentation. She noted that the research group requested updates from participants twice, but the current results may underrepresent patients with long-lasting symptoms.

The registry reveals further insight into the systemic inflammatory effects of COVID-19 and its persistent effects after recovery from acute infection. Health care providers can continue to submit cases by visiting www.aad.org/covidregistry.

Reference
1. McMahon DE, Gallman AE, Hruza GJ, et al. COVID-19 "long-haulers" in dermatology? Duration of dermatologic symptoms in an international registry from 39 countries. Late breaking abstract no 3090 presented at: EADV Virtual; October 29, 2020; virtual.

2. Freeman EE, McMahon DE, Lipoff JB. The spectrum of covid-19 associated dermatologic manifestations: an international registry of 716 patients from 31 countries. J Am Acad Dermatol. 2020;83(40):1118-1129. doi:10.1016/j.jaad.2020.06.1016

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