Cutaneous Symptoms May Indicate COVID-19 Infection

Cutaneous symptoms of SARS-CoV-2 may be helpful in diagnosing COVID-19 infection and identifying new variants.

Cutaneous symptoms are predictive of COVID-19 infection and could help identify new variants, according to a community-based retrospective study published in the British Journal of Dermatology.

Investigators collected self-reported data from UK users of the ZOE COVID Study app and matched data 1:1 for age, sex, vaccination status, and self-reported eczema diagnosis between those reporting symptoms during the Delta (June 27-November 27, 2021) wave and those reporting symptoms during the Omicron (December 20-February 23, 2022) wave. The main outcome of the study was the diagnostic value, frequency and duration of 5 cutaneous manifestations of SARS-CoV-2 infection: acral, burning, erythematopapular and urticarial rash, and unusual hair loss. Investigators also assessed the effect of a user’s vaccination status on self-reported symptoms using the Fisher exact test on a subgroup of SARS-CoV-2 users matched 1:1 for age, sex, and self-reported eczema diagnosis.

Investigators compared categorical values using the Pearson X2-test or Fisher exact test, and continuous values using the Wilcoxon test or linear regression after correcting for age and sex. They analyzed associations between self-reported cutaneous symptoms, either present or absent, and SARS-CoV-2 test results using multivariate logistic regression.

Of 348 691 users who self-reported data, 66.9% were women, the mean age was 46.5 (SD, 17.7) years, and 95% were White. There was a significantly higher prevalence of cutaneous symptoms among those infected with SARS-CoV-2 in both the Delta (odds ratio [OR], 2.29; 95% CI, 2.22-2.36; P <.001) and Omicron (OR, 1.29; 95% CI, 1.26-1.33; P <.001) waves, with burning rash the most commonly reported symptom. Well-known SARS-CoV-2 manifestations such as fever and rash had similar ORs in both waves as well, suggesting a similar diagnostic value to skin symptoms.

Monitoring these changes may help in identifying the emergence of new variants and it is particularly important now that several national surveillance studies, including those involving genomic sequencing, have been scaled back or terminated.

The diagnostic value of all cutaneous symptoms was higher in the Delta wave than the Omicron wave, consistent with the finding that cutaneous symptoms were more common during the Delta wave than the Omicron wave (17.6% vs 11.4%; Fisher’s test: P <.001). All cutaneous manifestations besides acral rash showed a longer duration on average during the Delta wave than the Omicron wave (Wilcoxon test: P <.002). Cutaneous symptoms mostly clustered with other symptoms of SARS-CoV-2 such as headache, runny nose, and sore throat. Cutaneous symptoms were similar in vaccinated and unvaccinated users, except for burning rash, which was less common in vaccinated users.

The study is limited by the self-selected group and self-reported data it is based on.

Monitoring changes in cutaneous manifestations of SARS-CoV-2 “may help in identifying the emergence of new variants and it is particularly important now that several national surveillance studies, including those involving genomic sequencing, have been scaled back or terminated,” the study authors wrote.

References:

Visconti A, Murray B, Rossi N, et al. Cutaneous manifestations of SARS-CoV-2 infection during the Delta and Omicron waves in 348 691 UK users of the UK ZOE COVID Study app. Br J Dermatol. Published online July 22, 2022. doi:10.1111/bjd.21784