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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Why We Need to Stop Linking Beauty and Success With ‘Fair’ Skin

From depictions of ‘suitable’ marriage partners in Netflix series Indian Matchmaking to the on-going popularity of skin-lightening creams, colourism remains rife in certain communities. Here, writer Ayesha Muttucumaru details her complicated relationship with the word ‘fair’ – and why calling out shade bias is vital.



From Indian Matchmaking to the popularity of skin lightening creams, colourism is still rife. Here's why we need to about skin lightening creams


© Provided by Women’s Health UK
From Indian Matchmaking to the popularity of skin lightening creams, colourism is still rife. Here’s why we need to about skin lightening creams

They dropped the F-Bomb.’ From the moment my mum and I started watching Indian Matchmaking on Netflix, we felt it would only be a matter of time until the word that makes us wince like no other was uttered. The term in question? No, not a four lettered expletive, but something far more insidious. ‘Fair.’



a woman smiling for the camera: The author


The author

As you might know, the docu-series follows ‘Mumbai’s top matchmaker,’ Sima Taparia, as she helps a range of single people in India and the US, with the help of their families, find their future wife or husband. The format has proven divisive. Criticisms levied by certain members of the Indian diaspora on Twitter include that some of the show’s participants engage in caste-discrimintion, mostly using euphemistic terms (‘from a good family’, ‘similar backgrounds’), as well as colourism (a prejudice or discrimination towards those with dark skin that usually occurs within the same ethnic group).

The latter is seen when some participants request a match with ‘fair’ skin. As well as affecting those with darker complexions in south Asian communities, it should be noted that attitudes such as these can lead people down a dangerous road to anti-Blackness.

These statements, some said, go unchallenged by Taparia, which could lead to the normalisation or affirmation of such views. (Speaking to The Cut, Smriti Mundhra, the show’s executive producer, said that she welcomes critique: ‘We’re now at a point where we can actually hold representation to a higher standard and push for better and more nuanced stories. I want to be held accountable. Push me so I can push too.’)

Why the word ‘fair’ is problematic

As to why the word ‘fair’ is an issue? Short story: it is not just seen as a way to denote someone’s appearance, but a character trait, having become synonymous with a person’s place in society, their chances of professional success, status and self-worth. The connotations go far beyond the superficial.

Sounds archaic, right? However, seeing one US-based show contestant casually list: ‘not too dark’ and ‘fair skin’ as a preferred ‘want’ in a potential parter was a stark reminder that colourism seems to be very much alive and kicking, even in my millennial generation.

The history of colourism in south Asian communities

Colonialism and the caste system are two of the reasons attributed to enduring colourist attitudes, as is the way skin colour is portrayed in the film industry, the media and by beauty brands. One notable example is the ‘fairness’ cream Fair & Lovely whose advertisements in India have historically implied that

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