Is there a POST‐COVID dermatological syndrome? The integrated dermato‐infectious disease experience of a single centre

This is the authors' abstract. We don't add key points for this paper.

With regard to 'long covid syndrome', an attempt was made to define possible dermatological manifestations.1-3 Devon E McMahon et al., through the establishment of a registry analysis of COVID-19 dermatological duration, assessed the duration of dermatological signs and symptoms of COVID-19 and the presence of patients with persistent skin manifestations. From April 8, 2020, to October 8, 2020, 1030 total cases and 331 laboratory-confirmed or suspected COVID-19 cases with dermatological manifestations were reported. Urticarial and morbilliform eruptions were relatively ephemeral, whereas papulos-squamous eruptions, particularly pernio, were long lasting.3 The limitation of this register is that skin manifestations have not been observed in the long term. For this reason, an integrated dermato-infectivological outpatient clinic has been set up at our centre, Azienda Ospedaliera Universitaria Umberto I Ancona, Italy. The objective was to evaluate, in patients with previous moderate to severe infection by SARS-CoV2, the presence of a 'long covid syndrome' with a focus on dermatological symptoms. One hundred and four patients were examined by a dermatologist and an infectivologist in the period from September 2020 to July 2021. The visits were carried out 1, 3 and 6 months after the patient's hospital discharge. A data collection form was set up and used by the doctors during the visits and all patients gave their consent to participate. The results are presented in Table 1. Of the 104 patients enrolled (mean age 61.6 ± 12.7), all (100%) completed observation at 1 month after discharge, 100 (96.15%) after 3 months and 89 (85.58%) after 6 months. Analysis of dermatological symptoms 1 month after hospital discharge (T1) showed that 14/104 (13.46%) patients had presented the following symptoms: 4/104 (3.85%) had telogen effluvium, 6/104 (5.77%) had skin xerosis, 2/104 (1.92%) had CPAP ulcers, 1/104 (0.96%) had diffuse folliculitis and 1/104 (0.96%) had pityriasis versicolor. After 3 months from hospital discharge, 30/100 (30.00%%) experienced dermatological symptoms: 24/100 (24.00%) telogen effluvium, 4/100 (4.00%) xerosis, 3/100 (3.00%) pruritus, 3/100 (3.00%) vesicular exanthema, 2/100 (2.00%) presented a relapse of seborrhoeic dermatitis, 1/100 (1.00%) relapse of psoriasis, 1/100 (1.09%) a CPAP ulcer, 1/100 (1.09%) the results of folliculitis. After 6 months from discharge, 10/89 (11.24%) patients showed dermatological symptoms: 5/89 (5.61%) showed persistence of telogen effluvium, 1 of which was associated with pruritus, 1/89 (1.12%) presented guttate psoriasis, 1/89 (1.12%) presented purpuric capillaritis resolved in 15 days, 1/89 (1.12%) presented intertrigo. Of the 30 patients who presented telogen effluvium (mean age 64.9 ± 11.1), all were Caucasian and the majority 27/30 (90%) were women. Analysis of dermatological symptoms 1 month after hospital discharge (T1) showed that 4/30 (13.33%) patients had presented the following symptoms: 4/30 (13.33%) had telogen effluvium and 1/30 (3.33%) also had skin xerosis. After 3 months from hospital discharge, 24/30 (80.00%) experienced dermatological symptoms: 24/30 (80.00%) telogen effluvium, 4/30 (13.33%) also had skin xerosis, 2/30 (6.66%) also had pruritus, 2/30 (6.66%) also had vesicular exanthema. After 6 months from discharge, 6/30 (20.00%) patients showed dermatological symptoms: 5/30 (16.60%) showed persistence of telogen effluvium, 1 of which was associated with pruritus, 1/30 (3.33%) presented guttate psoriasis. From the analysis of the population, it appears that patients who have suffered from SARS-CoV-2 infection do not seem to show specific dermatological manifestations referable to the 'Long Covid syndrome' except for Telogen Effluvium, in line with other reports in the literature.4-7 In addition, patients who experienced telogen effluvium had their peak hair loss approximately 3 months after infection (24/30, 80%), which would confirm that telogen effluvium is caused by an interruption of the anagen phase of the hair cycle (Late Onset Telogen effluvium).7, 8 In the literature, however, there are no data correlating the frequency of telogen effluvium with the epidemiological characteristics of the population affected by SARS Cov-2. There are reports in which the use of drugs, including enoxaparin, is correlated with the occurrence of telogen effluvium.5 The univariate statistical analysis used to compare the characteristics of the group of patients who presented with telogen effluvium with those who did not showed that there was a statistically significant difference in the sex of those involved, with telogen effluvium being found more frequently in females (Table 2). There was no statistically significant correlation with age, use of enoxaparin, severity of SARS-CoV2 pneumonia, that is persons who used any ventilatory support, and the latter figure differs from that found in the literature (Table 2). Therefore, telogen effluvium due to the interruption of the anagen phase seems to be the most frequent and specific dermatological manifestation in patients suffering from 'long covid syndrome' after severe SARS-CoV2 infection. All authors contributed to the writing of the manuscript. The authors declare no conflicts of interest. No funding sources have supported this study. Data available on request from the authors.