Diagnostic value of cutaneous manifestation of SARS-CoV-2 infection

TY - JOUR

T1 - Diagnostic value of cutaneous manifestation of SARS-CoV-2 infection

AU - Visconti, A

AU - Bataille, Veronique

AU - Rossi, N

AU - Kluk, J

AU - Murphy, R

AU - Puig, S

AU - Nambi, R

AU - Bowyer, R C E

AU - Murray, B

AU - Bournot, A

AU - Wolf, J

AU - Ourselin, S

AU - Steves, C J

AU - Spector, T D

AU - Falchi, M

N1 - Funding Information: Zoe Global Limited 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 Research (NIHR), Chronic Disease Research Foundation (CDRF), and the NIHR-funded BioResource, Clinical Research Facility and Biomedical Research Centre 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: © 2021 The Authors. British Journal of Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021/5

Y1 - 2021/5

N2 - Background: One of the challenging aspects of SARS-CoV-2 infection is its diverse multisystemic disease presentation. Objectives: To evaluate the diagnostic value of cutaneous manifestations of SARS-CoV-2 infection and investigate their duration and timing in relation to other COVID-19 symptoms. Methods: We used data from 336 847 UK users of the COVID Symptom Study app to assess the diagnostic value of body rash or an acral rash in SARS-CoV-2 infection, and data from an independent online survey of 11 544 respondents to investigate skin-specific symptoms and collect their photographs. Results: Using data from the app, we show significant association between skin rashes and a positive swab test result (odds ratio 1·67, 95% confidence interval 1·42–1·97). Strikingly, among the respondents of the independent online survey, we found that 17% of SARS-CoV-2-positive cases reported skin rashes as the first presentation, and 21% as the only clinical sign of COVID-19. Together with the British Association of Dermatologists, we have compiled a catalogue of images of the most common skin manifestations of COVID-19 from 400 individuals (https://covidskinsigns.com), which we have made publicly available to assist clinicians in recognition of this early clinical feature of COVID-19. Conclusions: Skin rashes cluster with other COVID-19 symptoms, are predictive of a positive swab test, and occur in a significant number of cases, either alone or before other classical symptoms. Recognizing rashes is important in identifying new and earlier cases of COVID-19.

AB - Background: One of the challenging aspects of SARS-CoV-2 infection is its diverse multisystemic disease presentation. Objectives: To evaluate the diagnostic value of cutaneous manifestations of SARS-CoV-2 infection and investigate their duration and timing in relation to other COVID-19 symptoms. Methods: We used data from 336 847 UK users of the COVID Symptom Study app to assess the diagnostic value of body rash or an acral rash in SARS-CoV-2 infection, and data from an independent online survey of 11 544 respondents to investigate skin-specific symptoms and collect their photographs. Results: Using data from the app, we show significant association between skin rashes and a positive swab test result (odds ratio 1·67, 95% confidence interval 1·42–1·97). Strikingly, among the respondents of the independent online survey, we found that 17% of SARS-CoV-2-positive cases reported skin rashes as the first presentation, and 21% as the only clinical sign of COVID-19. Together with the British Association of Dermatologists, we have compiled a catalogue of images of the most common skin manifestations of COVID-19 from 400 individuals (https://covidskinsigns.com), which we have made publicly available to assist clinicians in recognition of this early clinical feature of COVID-19. Conclusions: Skin rashes cluster with other COVID-19 symptoms, are predictive of a positive swab test, and occur in a significant number of cases, either alone or before other classical symptoms. Recognizing rashes is important in identifying new and earlier cases of COVID-19.

UR - http://www.scopus.com/inward/record.url?scp=85101867071&partnerID=8YFLogxK

U2 - 10.1111/bjd.19807

DO - 10.1111/bjd.19807

M3 - Article

C2 - 33448030

SN - 0007-0963

VL - 184

SP - 880

EP - 887

JO - The British journal of dermatology

JF - The British journal of dermatology

IS - 5

ER -