Department of Twin Research & Genetic Epidemiology, King's College London, London, UK.
School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK.
Br J Dermatol. 2022 Dec;187(6):900-908. doi: 10.1111/bjd.21784. Epub 2022 Oct 10.
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.
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.
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.
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.
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.
SARS-CoV-2 感染的症状在疫情的不同波次中有所不同，但人们对皮肤表现的变化知之甚少。
调查 SARS-CoV-2 感染的皮肤表现的诊断价值、频率和持续时间，并探讨其在德尔塔和奥密克戎波次之间的变化。
在这项回顾性研究中，我们使用了来自英国 ZOE COVID 研究应用程序的 348091 名用户的自我报告数据，这些用户在德尔塔和奥密克戎波次之间按年龄、性别、疫苗接种状态和自我报告的湿疹诊断进行了 1:1 匹配，以评估五种 SARS-CoV-2 感染的皮肤表现（肢端、灼热、红斑丘疹和荨麻疹以及异常脱发）的诊断价值、频率和持续时间，以及这些表现如何在波次之间变化。我们还调查了疫苗接种是否对症状频率有任何影响。
我们显示任何皮肤表现与 SARS-CoV-2 检测结果呈阳性之间存在显著关联，德尔塔波次的诊断价值高于奥密克戎波次（比值比 2.29，95%置信区间 2.22-2.36，P<0.001；比值比 1.29，95%置信区间 1.26-1.33，P<0.001）。与奥密克戎波次相比，皮肤表现也更为常见（分别为 17.6%和 11.4%），且持续时间更长。在两个波次中，皮肤症状与其他常见症状聚集在一起，很少（<2%的用户）作为 SARS-CoV-2 感染的首发或唯一临床体征。最后，我们观察到接种疫苗和未接种疫苗的用户出现皮肤表现的几率相似，除了灼热疹，接种疫苗的用户出现这种皮疹的几率较低。
皮肤表现可预测 SARS-CoV-2 感染，其频率和持续时间随不同变体而变化。因此，我们主张将其纳入有临床意义的 COVID-19 症状列表，并建议监测这些症状可以帮助识别新变体。
关于这个主题，已经知道些什么？在野生型 COVID-19 波次期间，几项研究报告称患者出现了常见的皮肤相关症状。已经观察到 COVID-19 症状在不同变体之间存在差异。目前还没有研究关注皮肤相关症状在不同变体之间是如何变化的。这项研究增加了什么新内容？我们在一项包括超过 348000 人的基于社区的回顾性研究中表明，在德尔塔和奥密克戎波次中，皮肤症状的存在可预测 SARS-CoV-2 感染，这种诊断价值以及症状的频率和持续时间在变体之间存在差异。我们表明，在德尔塔和奥密克戎波次期间，感染的接种疫苗和未接种疫苗的个体报告了类似的皮肤相关症状，只有灼热疹在接种疫苗后不太常见。
