Coronavirus

The spread of the SARS-Cov2 at the beginning of 2020 led to lockdowns in many parts of the world. Whilst early symptoms were fever and persistent cough with frequent hospital admissions, it became very clear within a few months that COVID infections led to many different clinical presentations including rashes. However, during the first part of 2020, it was difficult to confirm infection because of the lack of PCR testing. Many COVID cases did not need admission and access to GPs or dermatologists was difficult with no easy access to healthcare. It therefore took some time for dermatologists around the world to notice a high prevalence of skin eruptions during the first part of 2020. Twitter (now known as X) and WhatsApp were quite useful to report these early presentations amongst dermatologists. A little later, case reports and case series appeared which supported the view that COVID infections significantly affected the skin. Widespread erythemato-papular rashes were the commonest followed by urticaria. COVID digits one of the most specific presentations of COVID infection was the most puzzling at first. With the increasing number of cases in young people with mild COVID infection and the presence of the SARS-Cov2 spike protein in endothelial walls from acral sites, the link was eventually confirmed. COVID vaccination started at the beginning of 2021 and this also led to skin side effects which were not dissimilar to COVID infections. Fruitful collaborations around the world with phone apps, eCRFs and other web-based data collection were very instrumental for the collection of data on COVID symptoms and side effects of vaccination. This changed the way clinical research could be conducted as public engagement was much better than expected and the collection of large datasets was fast and efficient.