Skin Symptoms Common in COVID ‘Long-Haulers’

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A small subset of SARS-CoV-2 patients with “COVID toes” can be categorized as COVID long-haulers, with skin symptoms sometimes enduring for more than 150 days, a new analysis revealed.

Evaluating data from an international registry of COVID-19 patients with dermatologic symptoms, researchers found that retiform purpura rashes are linked to severe COVID-19, with 100% of these patients requiring hospitalization and 82% experiencing acute respiratory distress syndrome (ARDS).

Meanwhile, pernio/chilblains rashes, dubbed “COVID toes,” are associated with milder disease and a 16% hospitalization rate. For all COVID-related skin symptoms, the average duration is 12 days.

“The skin is another organ system that we didn’t know could have long COVID” effects, said principal investigator Esther Freeman, MD, PhD, from Massachusetts General Hospital and Harvard Medical School in Boston.

Dr Esther Freeman

“The skin is really a window into how the body is working overall, so the fact that we could visually see persistent inflammation in long-hauler patients is particularly fascinating and gives us a chance to explore what’s going on,” Freeman told Medscape Medical News. “It certainly makes sense to me, knowing what we know about other organ systems, that there might be some long-lasting inflammation” in the skin as well.

The study is a result of the collaboration between the American Academy of Dermatology and the International League of Dermatological Societies, the international registry launched this past April. While the study included provider-supplied data from 990 cases spanning 39 countries, the registry now encompasses more than 1000 patients from 41 countries, Freeman noted.

Freeman presented the data at the virtual 29th European Academy of Dermatology and Venereology (EADV) Congress.

Many studies have reported dermatologic effects of COVID-19 infection, she said, but information was lacking about duration. The registry represents the largest dataset to date detailing these persistent skin symptoms and offers insight about how COVID-19 can affect many different organ systems even after patients recover from acute infection, Freeman said.

Eight different types of skin rashes were noted in the study group, of which 303 were lab-confirmed or suspected COVID-19 patients with skin symptoms. Of those, 224 total cases and 90 lab-confirmed cases included information on how long skin symptoms lasted. Lab tests for SARS-CoV-2 included PCR and serum antibody assays.

Freeman and her team defined “long haulers” as patients with dermatologic symptoms of COVID-19 lasting 60 days or longer. These “outliers” are likely more prevalent than the registry suggests, she said, since not all providers initially reporting skin symptoms in patients updated that information over time.

“It’s important to understand that the registry is probably significantly underreporting the duration of symptoms and number of long-hauler patients,” she explained. “A registry is often a glimpse into a moment in time to these patients. To combat that, we followed up by email twice with providers to ask if patients’ symptoms were still ongoing or completed.”

Results showed a wide spectrum in average duration of symptoms among lab-confirmed

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The ‘long-haulers’: Why ‘presumed recovered’ doesn’t mean you’re done with the coronavirus | Coronavirus

Dr. Shaban Faruqui, strapped into a gurney, rolled down the hallway five months ago at Baton Rouge General Medical Center to cheers and applause from the hospital’s employees.

It was May 18, two months after he was hospitalized with the coronavirus. As the former chief of gastroenterology at the hospital, everyone had been rooting for him.

He had survived the worst of it and was going home. To a wife of 45 years, to three daughters and four grandchildren who had hung paintings of hearts and sunny skies on the walls of his Baton Rouge home to greet him.

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Dr. Shaban Faruqui and his wife and three daughters in 2015. 

When he arrived home in the ambulance, Faruqui’s fingers fluttered with urgency when he saw his wife. She grabbed his hand. A doctor herself, she would oversee his care as he recovered.

That day marked what the Faruqui family thought would be the end of a long struggle with the coronavirus.

It wasn’t.

What they didn’t realize then, and what is becoming clear to some other coronavirus patients and their families, is that the fight for survival doesn’t end when a patient leaves the hospital.

Presumed recovered

On the Louisiana Department of Health website, a hopeful green number ticks up each week in the left corner of the state’s coronavirus dashboard. It represents the many “presumed recovered” people who survived their initial infection. There are 161,792 of them in Louisiana as of the most recent count.

The state considers someone recovered if they meet one of two criteria. Either it has been more than 14 days since they tested positive and they aren’t in a hospital or dead, or if they are still alive 21 days after a positive test.

The assumption baked into the dashboard is that people are through the worst of the infection if they’re out of the hospital or a few weeks out from the initial sickness. The majority of people recover in that time period.

But the metric was created before there was an understanding of the continuing coronavirus-related symptoms that some people face. And more and more, doctors say that many of those “presumed recovered” patients still are far from certain to have a full recovery.

“I don’t presume all those people are recovered. A lot of those people are still sick,” said Dr. Josh Denson, a pulmonologist who in March treated the first severe case of COVID-19 that occurred at University Medical Center in New Orleans.

How a 31-year-old New Orleans coronavirus survivor died from a rarely seen condition weeks later

A 31-year-old woman checked in to a New Orleans hospital this spring after five days of fever, cough and stomach pain. Hospital workers stuck …

While COVID-19 affects the respiratory system — shortness of breath, low blood oxygen, pneumonia and acute respiratory distress syndrome in severe cases — mounting evidence shows it can impact a number of different organs, in some cases leaving behind undetectable damage or persistent problems that can turn severe weeks later.

Some of these people are

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