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

Alessia Visconti; Benjamin Murray; Niccolò Rossi; Jonathan Wolf; Sebastien Ourselin; Tim D Spector; Esther E Freeman; Veronique Bataille; Mario Falchi

doi:10.1111/bjd.21784

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

Alessia Visconti, Benjamin Murray, Niccolò Rossi, Jonathan Wolf, Sebastien Ourselin, Tim D Spector, Esther E Freeman, Veronique Bataille, Mario Falchi

Zoe Ltd

Research output: Contribution to journal › Article › peer-review

17 Citations (Scopus)

Abstract

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.

Original language	English
Pages (from-to)	900-908
Number of pages	9
Journal	The British journal of dermatology
Volume	187
Issue number	6
Early online date	22 Jul 2022
DOIs	https://doi.org/10.1111/bjd.21784
Publication status	Published - Dec 2022

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10.1111/bjd.21784

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@article{24df3d2846b441cdaf6daa8c1d855f12,

title = "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",

abstract = "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.",

author = "Alessia Visconti and Benjamin Murray and Niccol{\`o} Rossi and Jonathan Wolf and Sebastien Ourselin and Spector, {Tim D} and Freeman, {Esther E} and Veronique Bataille and Mario Falchi",

note = "Funding Information: ZOE Ltd provided in-kind support for all aspects of building, running and supporting the app and service to all users worldwide. Investigators received support from the Wellcome Trust, the Medical Research Council/British Heart Foundation, Alzheimer{\textquoteright}s Society, European Union, National Institute for Health and Care Research (NIHR), Chronic Disease Research Foundation, and the NIHR-funded BioResource, Clinical Research Facility and Biomedical Research Council based at Guy{\textquoteright}s and St Thomas{\textquoteright} NHS Foundation Trust in partnership with King{\textquoteright}s College London. This work was also supported by the UK Research and Innovation London Medical Imaging & Artificial Intelligence Centre for Value Based Healthcare. Funding Information: ZOE Ltd provided in‐kind support for all aspects of building, running and supporting the app and service to all users worldwide. Investigators received support from the Wellcome Trust, the Medical Research Council/British Heart Foundation, Alzheimer{\textquoteright}s Society, European Union, National Institute for Health and Care Research (NIHR), Chronic Disease Research Foundation, and the NIHR‐funded BioResource, Clinical Research Facility and Biomedical Research Council based at Guy{\textquoteright}s and St Thomas{\textquoteright} NHS Foundation Trust in partnership with King{\textquoteright}s College London. This work was also supported by the UK Research and Innovation London Medical Imaging & Artificial Intelligence Centre for Value Based Healthcare. Publisher Copyright: {\textcopyright} 2022 The Authors. British Journal of Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists.",

year = "2022",

month = dec,

doi = "10.1111/bjd.21784",

language = "English",

volume = "187",

pages = "900--908",

journal = "The British journal of dermatology",

issn = "0007-0963",

publisher = "John Wiley & Sons, Ltd (10.1111)",

number = "6",

}

TY - JOUR

T1 - 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

AU - Visconti, Alessia

AU - Murray, Benjamin

AU - Rossi, Niccolò

AU - Wolf, Jonathan

AU - Ourselin, Sebastien

AU - Spector, Tim D

AU - Freeman, Esther E

AU - Bataille, Veronique

AU - Falchi, Mario

N1 - Funding Information: ZOE Ltd provided in-kind support for all aspects of building, running and supporting the app and service to all users worldwide. Investigators received support from the Wellcome Trust, the Medical Research Council/British Heart Foundation, Alzheimer’s Society, European Union, National Institute for Health and Care Research (NIHR), Chronic Disease Research Foundation, and the NIHR-funded BioResource, Clinical Research Facility and Biomedical Research Council based at Guy’s and St Thomas’ NHS Foundation Trust in partnership with King’s College London. This work was also supported by the UK Research and Innovation London Medical Imaging & Artificial Intelligence Centre for Value Based Healthcare. Funding Information: ZOE Ltd provided in‐kind support for all aspects of building, running and supporting the app and service to all users worldwide. Investigators received support from the Wellcome Trust, the Medical Research Council/British Heart Foundation, Alzheimer’s Society, European Union, National Institute for Health and Care Research (NIHR), Chronic Disease Research Foundation, and the NIHR‐funded BioResource, Clinical Research Facility and Biomedical Research Council based at Guy’s and St Thomas’ NHS Foundation Trust in partnership with King’s College London. This work was also supported by the UK Research and Innovation London Medical Imaging & Artificial Intelligence Centre for Value Based Healthcare. Publisher Copyright: © 2022 The Authors. British Journal of Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists.

PY - 2022/12

Y1 - 2022/12

N2 - 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.

AB - 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.

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U2 - 10.1111/bjd.21784

DO - 10.1111/bjd.21784

M3 - Article

C2 - 35869671

SN - 0007-0963

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JO - The British journal of dermatology

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ER -

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

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