COVID Skin Signs Vary by Type of Variant, UK Study Finds


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Skin symptoms, like systemic symptoms, vary by variant of COVID-19, according to a large retrospective study that compared clinical data from more than 300,000 participants in the United Kingdom during Omicron and Delta waves.

Among the main findings, the study shows that skin lesions were less common during the Omicron wave than during the Delta wave (11.4% vs. 17.6%), skin symptoms generally resolved more quickly, and that the risk of skin symptoms was similar across patients. . were or were not vaccinated, according to a team led by Alessia Visconti, Ph.D., research assistant in the Department of Twin Research and Genetic Epidemiology at King’s College London.


This data is consistent with the experience of those dermatologists who closely monitor this area, according to Esther Freeman, MD, assistant professor of dermatology at Harvard Medical School and director of MGH Global Health Dermatology at Massachusetts General Hospital, both in Boston. .

“Oddly enough, we thought we were seeing fewer skin symptoms with Omicron compared to Delta and the ancestral strains, and now this study shows that this is true,” said Freeman, who is also the principal investigator for the American COVID-19 International Dermatology Registry. academy of dermatology. .

The data also confirms that the skin is less susceptible to damage than in past waves of COVID-19 infections.


“Until this point, it was difficult to know if we were seeing fewer skin rashes associated with COVID, or whether doctors were just used to these rashes and not being treated as often,” added Freeman, who was one of the co-authors of the study.

Data collected from 348,691 patients

The study data was generated by 348,691 users in the United Kingdom of the ZOE COVID research app, a smartphone tool introduced relatively early during the pandemic. He asked users to provide demographic data, information about COVID-19 symptoms, including skin symptoms, and treatments. Of the 33 COVID-related symptoms included in the app, five are skin related (acral rash, stinging rash, rash erythematopapular, urticarial rash, and unusual hair loss).

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Although the purpose of this study was to compare skin manifestations during the Omicron wave with the Delta wave of COVID-19, the investigators also had data on the 2020 experience with wild-type COVID-19 that preceded both. Overall, it showed a stepwise reduction in overall skin symptoms as well as skin symptoms that occurred in the absence of systemic symptoms.

“The shift in skin manifestations makes sense when you think about the change that is also seen in systemic symptoms,” Freeman said, referring to lower rates of cough and loss of smell, but higher rates of sore throat and fatigue. “Omicron eludes the immune system, so there is a shift in the affected tissues,” she said in an interview.

Previous data collected by the same group of investigators during the wild-type stage of the COVID-19 pandemic showed that 17% of patients reported skin rash as the first symptom of COVID-19 infection, and 21% reported skin rash as the only clinical symptom. sign of infection.


In Delta and Omicron waves, skin rash was an isolated initial symptom in only 0.8% and 0.5% of patients, respectively. (The authors noted that in the United Kingdom, the first documented examples of the Delta variant were found in October 2020 and the first documented examples of the Omicron variant were found in November 2021.)

In the early stages of wild-type COVID, an acral rash was characteristic, occurring in 3.1% of patients, according to the UK. In the delta wave, acral rashes at a frequency of 1.1% remained positively correlated with a diagnosis of COVID-19 infection. In the Omicron wave, acral rashes were observed in only 0.7% of patients and were no longer statistically correlated with a positive COVID diagnosis.

Characteristic skin symptoms develop

At the beginning of the COVID-19 epidemic, more than 30 types of rash were observed in patients with COVID-19 infection. Skin symptoms are still varied, but some, such as acral rash, are less common. For example, the odds ratio of a positive diagnosis of COVID-19 among patients with erythematopapular rash fell from 1.76 to 1.08 between delta and omicron waves.

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Although specific skin symptoms are less predictive of a COVID-19 diagnosis, clinicians should not dismiss skin symptoms as a sign of illness, according to Véronique Bataille, MD, consultant dermatologist at King’s College.

“You have to be open-minded” about skin signs and the diagnosis of COVID-19, Bataille, one of the co-authors of the UK report, said in an interview. In general, she considers a low threshold of suspicion appropriate. “If the patient does not have a history of skin disease and other rash triggers, then COVID should be suspected in an area of ​​high prevalence.”

In most cases, the rash clears up on its own, but Bataille emphasizes the need for personalized care. While the risk of life-threatening COVID-19 infections appears to be decreasing with current options, skin manifestations can be severe.

“There are cases of long-term exposure to COVID on the skin, such as urticaria or lichenoid erythemato-papular rash, which can cause severe itching and are difficult to control,” she said.

Freeman reiterated the importance of the individual approach. She agreed that most skin symptoms go away on their own, but there are exceptions and treatments vary for different types of skin lesions. “I think another point to consider when looking at skin lesions is monkeypox. The fact that these flashes overlap each other should not be ignored. You have to be on the lookout for both.”

Visconti, Freeman and Bataille reported no potential conflicts of interest.

This article originally appeared on, part of the Medscape professional network.


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