P20: Understanding dermatological concerns in people experiencing homelessness: a scoping review and discussion for improved delivery of care

Abstract

P19 Cutaneous manifestations of COVID-19 in the UK: a registry of digital submissions from interdisciplinary healthcare professionals C. Psomadakis, A. Connolly, L. Nestor, S. Walsh and E. Craythorne Guy’s and St Thomas’ Hospital, London, UK; Guy’s and St Thomas’, London, UK; Royal Berkshire Hospital, Reading, UK; and King’s College Hospital, London, UK Initial reports of cutaneous signs associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were reported in February 2020 in an Italian cohort (Recalcati S. Cutaneous manifestations in COVID-19: a first perspective. J Eur Acad Dermatol Venereol 2020; 34: e212–13). The global spread of the virus led to increased recognition of cutaneous reaction patterns associated with COVID-19. Worldwide, national registries were established to capture dermatological manifestations, and here we report the data collected in the UK. In the spring of 2020, under the auspices of the British Association of Dermatologists, we launched a registry for healthcare professionals to report dermatological presentations in patients with symptoms suggestive of COVID-19 disease. The registry was distributed via email to professional bodies, as well as via digital messaging communication tools. Cases were submitted by dermatologists, intensive care doctors, podiatrists, general practitioners and doctors of internal medicine from the UK and the Republic of Ireland. The registry was open until October 2020, reflecting the first ‘wave’ of COVID-19. We received information on 150 patients, including data in the following categories: demographic information (ethnicity, age, sex and geographical location), rash morphology, onset of cutaneous features relative to systemic symptoms, COVID19 swab status, disease severity, investigations, treatment and outcomes. The registry allowed entry of histopathology results and clinical photographs. The project was submitted to the Health Research Authority for review and no further approval was required. In our cohort, 41% of patients (n = 62) had confirmed COVID-19 infection, while the remainder manifested symptoms strongly suggestive of this diagnosis. Cutaneous manifestations were the only sign of infection in 23% (n = 35) of cases. Where systemic symptoms were present, skin signs were a late manifestation of illness [n = 81 (54%)]. The most common skin sign was acral erythema/oedema-like chilblains [n = 65 (38%)], followed by a maculopapular [n = 36 (24%)], urticarial [n = 18 (12%)] or vasculitic [n = 10 (6%)] rash. Most commonly, cutaneous manifestations resolved spontaneously within 2 weeks without treatment [n = 43 (28%)]. The pattern of cutaneous signs of SARS-CoV-2 in our registry mirrored the findings of other national registries (Galv an Casas C, Catal a A, Carretero Hern andez et al. Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases. Br J Dermatol 2020; 183: 71–7). Our results are likely to underestimate the incidence of skin signs, as most occur in patients who are otherwise asymptomatic.