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.

BACKGROUND: Symptoms of SARS-CoV-2 infection have differed during the different waves of the pandemic but little is known about how cutaneous manifestations have changed. OBJECTIVES: To investigate the diagnostic value, frequency and duration of cutaneous manifestations of SARS-CoV-2 infection and to explore their variations between the Delta and Omicron waves of the pandemic. METHODS: In this retrospective study, we used self-reported data from 348 691 UK users of the ZOE COVID Study app, matched 1 : 1 for age, sex, vaccination status and self-reported eczema diagnosis between the Delta and Omicron waves, to assess the diagnostic value, frequency and duration of five cutaneous manifestations of SARS-CoV-2 infection (acral, burning, erythematopapular and urticarial rash, and unusual hair loss), and how these changed between waves. We also investigated whether vaccination had any effect on symptom frequency. RESULTS: We show a significant association between any cutaneous manifestations and a positive SARS-CoV-2 test result, with a diagnostic value higher in the Delta compared with the Omicron wave (odds ratio 2·29, 95% confidence interval 2·22-2·36, P < 0·001; and odds ratio 1·29, 95% confidence interval 1·26-1·33, P < 0·001, respectively). Cutaneous manifestations were also more common with Delta vs. Omicron (17·6% vs. 11·4%, respectively) and had a longer duration. During both waves, cutaneous symptoms clustered with other frequent symptoms and rarely (in < 2% of the users) as first or only clinical sign of SARS-CoV-2 infection. Finally, we observed that vaccinated and unvaccinated users showed similar odds of presenting with a cutaneous manifestation, apart from burning rash, where the odds were lower in vaccinated users. CONCLUSIONS: Cutaneous manifestations are predictive of SARS-CoV-2 infection, and their frequency and duration have changed with different variants. Therefore, we advocate for their inclusion in the list of clinically relevant COVID-19 symptoms and suggest that their monitoring could help identify new variants. What is already known about this topic? Several studies during the wildtype COVID-19 wave reported that patients presented with common skin-related symptoms. It has been observed that COVID-19 symptoms differ among variants. No study has focused on how skin-related symptoms have changed across different variants. What does this study add? We showed, in a community-based retrospective study including over 348 000 individuals, that the presence of cutaneous symptoms is predictive of SARS-CoV-2 infection during the Delta and Omicron waves and that this diagnostic value, along with symptom frequency and duration, differs between variants. We showed that infected vaccinated and unvaccinated individuals reported similar skin-related symptoms during the Delta and Omicron waves, with only burning rashes being less common after vaccination.

Oral manifestations of monkeypox: Brief review.

The current outbreak of monkeypox infection has caught the attention of people worldwide. Updated data showed a dramatic increase in the number of patients in many non-endemic countries. An emergence of monkeypox together with coronavirus disease 2019 (COVID-19) caused a tremendous burden on the healthcare system, globally. The aim of this review was to briefly describe the current situation, transmission, clinical features, diagnosis, and prevention of the disease. Oral manifestations of monkeypox as well as those of similar viral diseases were elaborately delineated. The outbreak of monkeypox in non-endemic regions has expanded to at least 47 countries with more than 4,100 new infections. The clinical features in non-endemic regions are atypical and different from those in central and western Africa. Milder symptoms with no death cases have been observed. The oral mucosa is often involved and oral lesions may initially be manifested before the rash spreads to the face and other parts of the body. The diagnosis of monkeypox is mainly based on clinical presentations and laboratory investigations. Prevention by avoiding close contacts with patients and sick animals and providing vaccination to those who have a primary contact with patients is essential. Oral manifestations may occur prior to skin eruptions, suggesting that dentists and dental personnel should be well aware of the nature of the disease. Prevention and public awareness of the disease are crucial for mitigating further human-to-human transmission.

Adverse cutaneous reactions reported post COVID-19 vaccination in Al Buraimi governorate, Sultanate of Oman.

On March 11, 2020, the World Health Organization (WHO) declared the novel coronavirus (COVID-19) a global pandemic. This has led to the rapid development and emergency approval of vaccines to overcome the alarming spread of the virus. Data on the cutaneous side effects related to the COVID-19 vaccine remains limited. In this prospective observational study, which was conducted from June 20 to September 20, 2021, we evaluated the incidence and various patterns of cutaneous side effects reported post COVID-19 vaccination in Al Buraimi Governorate in Oman. All vaccinated individuals aged 12 years and older, who had a skin reaction within 4 weeks following any dose of the COVID-19 vaccine, were enrolled in the study. The demographic data, medical history, vaccine-related information of all the patients were documented and the analysis was performed using the SPSS version 23 software. In total, 67 cutaneous reactions were reported by 55 patients accounting for 0.11% of all vaccinated individuals. The mean age of the patients was 33.3 years, 80.6% were females, 61.2% of the reactions were reported after the first vaccine dose, and 38.8% were reported after the second dose. We observed a wide range of cutaneous reactions and categorized them into three major patterns: local injection site reaction (2%), new onset rash (81.6%), and flare up of pre-existing dermatological conditions (16.4%). Notably, urticaria was the most common reaction overall, followed by generalized pruritus and maculopapular rash. In general, we reported a diversity of cutaneous side effects that healthcare workers should be aware of as some reactions may be overlooked and not linked to the COVID-19 vaccination.

Clinical observation and analysis of skin reactions caused by COVID-19 vaccination.

The novel coronavirus disease 2019 (COVID-19) vaccination is now an essential strategy for controlling the COVID-19 epidemic. This study included 132 cases of adverse skin reactions after the injection of COVID-19 vaccination from January 2021 to January 2022. The rate of adverse skin reactions after the 1st, 2nd, and 3rd doses of the COVID-19 vaccine were 52%, 40%, and 8% of total adverse skin reactions, respectively. The Urticaria-like rash was the most common manifestation of all adverse skin reactions, accounting for 40.15% of all adverse reactions. The Eczema-like rash was 27.27%. The rates of adverse skin reactions after vaccination with the COVID-19 vaccine in patients with a previous skin disease was 12.12%. Other rare skin adverse reactions after COVID-19 vaccination included herpes zoster, pityriasis rosea, erythema multiforme, chickenpox, herpes simplex, psoriasis, erythrodermatitis, arthus reaction, lichen planus recurrence, measles-like rash, frostbite rash, seborrhea, and vitiligo. There were 23 cases of adverse skin reactions in the same individual after two doses of COVID-19 vaccine. There were three cases of adverse skin reactions in the same person after three doses of the vaccine. Treatment measures are mostly mild regimens, such as oral antihistamines, compounded glycopyrrolate and topical weak to moderately potent corticosteroid creams. The total duration of these skin adverse reactions ranged from 2 weeks to 1 month.

Clinical Patterns and Morphology of COVID-19 Dermatology.

Coronavirus disease 2019 (COVID-19), an emergent disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread throughout the globe since its discovery in December 2019. Although first appreciated to cause pneumonia, numerous organ systems are now known to be involved. The objective of this article is to review the broad spectrum of cutaneous manifestations reported in association with SARS-CoV-2 infection. The most commonly reported cutaneous manifestations associated with COVID-19 infection include pernio (chilblain)-like acral lesions, morbilliform (exanthematous) rash, urticaria, vesicular (varicella-like) eruptions, and vaso-occlusive lesions (livedo racemosa, retiform purpura). It is important to consider SARS-CoV-2 infection in the differential diagnosis of a patient presenting with these lesions in the appropriate clinical context, as cutaneous manifestations may be present in otherwise asymptomatic individuals, or present before developing other symptoms of infection. With increased access to diagnostic testing, we are beginning to understand the utility and limitations of currently available assays.

Cutaneous manifestations in an Italian military COVID hub.

BACKGROUND: The outbreak of the pandemic Coronavirus disease 2019 (COVID-19), caused by a novel coronavirus named Severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2), affecting a high number of patients in Italy, forced a great number of doctors, even dermatologists, to work in the first lines in the dedicated departments. We analyzed the features and the incidence of dermatological issues emerged during the hospitalization due to COVID-19 and absent before. METHODS: All the SARS-CoV-2 positive patients hospitalized in Celio Military Hospital - COVID hub no-intensive care wards from March 16, 2020 until May 4, 2020 were evaluated by dermatologists several times during the hospital stay. RESULTS: Ninety-six patients (15 civilians and 81 Italian servicepeople) were enrolled: 34 (35.4%) patients developed cutaneous manifestations; 15 (16.0%) suffered from skin dryness; 5 (5.2%) irritant contact dermatitis; 4 (4.2%) seborrheic dermatitis; 4 (4.2%) morbilliform rashes; 3 (3.1%) petechial rashes and 3 (3.1%) widespread hives. CONCLUSIONS: A deeper knowledge of cutaneous manifestations in military and civilian hospitalized COVID-19 patients could suggest more effective treatments to win the battle against SARS-CoV-2.

The potential threat of multisystem inflammatory syndrome in children during the COVID-19 pandemic.

Multisystem inflammatory syndrome in children (MIS-C) during the COVID-19 pandemic raised a global alert from the Centers for Disease Control and Prevention's Health Alert Network. The main manifestations of MIS-C (also known as pediatric MIS (PMIS)) in the setting of a severe inflammatory state include fever, diarrhea, shock, and variable presence of rash, conjunctivitis, extremity edema, and mucous membrane changes. In some cases, these symptoms progressed to multi-organ failure. The low percentage of children with asymptomatic cases compared with mild illness and moderate illness could be correlated with the rare cases of MIS-C. One potential explanation for the progression to severe MIS-C disease despite the presence of readily detectable anti-SARS-CoV-2 antibodies could be due to the potential role of antibody-dependent enhancement (ADE). We reason that the incidence of the ADE phenomenon whereby the pathogen-specific antibodies can promote pathology should be considered in vaccine development against SARS-CoV-2.