Search Results (275)

Pruritus is a common and burdensome symptom in inflammatory, autoimmune, and connective tissue skin diseases, significantly impairing quality of life, sleep, and psychological well-being. Pruritus arises from a complex interplay between skin barrier dysfunction, immune activation, and neuronal sensitization involving cytokines, alarmins, neuropeptides, and sensory pathways. Increasing evidence indicates that both biological sex and gender-related factors influence itch perception, severity, and clinical expression, although these differences remain insufficiently explored. This review provides a comprehensive analysis of current evidence on sex- and gender-related differences in pruritus across dermatological diseases, with particular attention to the neuroimmune mechanisms underlying chronic itch. Available studies suggest that women more frequently report greater itch intensity, enhanced psychological burden, and higher impairment in daily activities and sleep, whereas men may exhibit different clinical and sensory profiles. However, findings remain heterogeneous because of methodological limitations, small cohorts, and the lack of standardized itch assessment tools. In addition to biological determinants, psychosocial and behavioral factors likely contribute to sex- and gender-specific differences in chronic pruritus. Overall, the available evidence highlights the need for more standardized and sex-informed research approaches to improve the understanding and management of pruritus in dermatological diseases. Full article

Background: Food hypersensitivity is frequently associated with gastrointestinal and systemic manifestations. This study aimed to evaluate the clinical, nutritional, biochemical, lifestyle characteristics, and stress levels of Lebanese adults with food hypersensitivity (cases) (n = 378) compared with controls (n = 397) (absence of food hypersensitivity). Methods: A case–control study was conducted among 775 Lebanese adults, including participants with self-reported food allergies and/or food intolerance and controls. Sociodemographic, clinical, and lifestyle data were collected. Dietary intake was assessed using validated dietary assessment tools. Biochemical parameters (n = 775), stool analyses (n = 297), and fecal calprotectin were evaluated. Results: Overall, 378 participants (48.8%) were classified as having food hypersensitivity. Dermatological, nasal, respiratory, and gastrointestinal symptoms were significantly more frequent among cases than controls (p < 0.05). Autoimmune diseases were more prevalent among cases. Daily energy and nutrient intake differed significantly between groups, with cases generally reporting lower intakes than controls. Cases exhibited substantially lower serum vitamin D, vitamin B12, and hematocrit levels. In binary logistic regression models, significant correlations were observed alongside key antioxidant and immunomodulatory micronutrients: vitamin C (OR = 0.604; 95% CI: 0.390–0.937), dietary vitamin D (OR = 0.079; 95% CI: 0.011–0.565), vitamin E (OR = 0.085; 95% CI: 0.013–0.568), and iron (OR = 0.025; 95% CI: 0.002–0.291). Conclusions: Biochemical and nutritional differences were observed despite generally adequate dietary intake. Reduced intakes of essential micronutrients, including antioxidant vitamins (vitamins C and E), vitamin D, and the essential mineral iron, emerged as primary independent predictors of food hypersensitivity. These findings highlight the core role of localized intestinal inflammation, specific dietary avoidance behaviors, and systemic immune modulation. Full article

Background: Skin aging is influenced by intrinsic and extrinsic factors that alter skin texture and microrelief. Non-invasive imaging techniques enable objective longitudinal assessment of these characteristics. This study aimed to instrumentally and subjectively evaluate skin surface changes during a standardized 90-day dermocosmetic regimen containing multiple active ingredients. Methods: This prospective, single-arm observational study included 47 women aged 30–60 years with visible signs of facial skin aging. Participants applied a standardized anti-age serum and cream regimen twice daily for 90 days. Skin surface morphology was assessed at baseline and after 30, 60, and 90 days using Visioscan^® VC 20plus imaging with SELS^® software. Subjective outcomes were evaluated using a structured product questionnaire and the validated Skindex-16 instrument. Results: Significant temporal changes were observed across objective skin surface parameters. From baseline to day 90, mean skin roughness decreased from 4.99 ± 2.29 to 1.66 ± 0.67, while the wrinkle-related parameter decreased from 191.08 ± 87.26 to 74.27 ± 15.25. Reductions were also observed in scaliness, contrast, entropy, variance, and anisotropy, whereas smoothness, homogeneity, and energy increased over time. Skindex-16 scores decreased across Symptoms, Emotions, and Functioning domains, indicating lower participant-reported dermatology-related burden. The regimen was well tolerated, with no serious adverse events reported. Conclusions: In this exploratory single-arm observational study, the standardized dermocosmetic regimen was associated with measurable longitudinal changes in Visioscan-derived skin surface parameters and patient-reported outcomes over 90 days. Because the study included no control group, the findings cannot establish causality or isolate the contribution of individual regimen components. Full article

Background: Traditional orthopaedic casting has remained the cornerstone of non-surgical fracture management for more than a century. Although plaster and fiberglass casts reliably stabilize fractures, they are associated with physical, psychological, emotional, social, and economic burdens that extend beyond bone healing. Children, older adults, and individuals with pre-existing vulnerabilities may be disproportionately affected. Despite increasing recognition of these complications, existing orthopaedic literature has historically prioritized radiographic healing and biomechanical stability, with limited synthesis of the broader multidimensional patient impact of traditional casting. Emerging technologies such as light-cured polymer mesh (LCPM) systems and 3D-printed lattice immobilizers have been developed to address these limitations and better align fracture care with patient-centered principles. Methods: A narrative review was conducted using a structured and transparent literature identification approach informed by PRISMA reporting principles; however, this study was not conducted as a formal systematic review and did not include risk-of-bias assessment or quantitative synthesis. A broad search of PubMed, Scopus, Web of Science, and Google Scholar was performed for studies published between January 2000 and July 2025. Search strategies combined MeSH terms and free-text keywords relating to orthopaedic casting, complications, psychosocial impacts, LCPM, and 3D-printed immobilizers. Following duplicate removal and a structured review process, 87 studies were included in the final narrative synthesis. Eligible studies included randomized controlled trials, observational studies, qualitative research, case series, and systematic reviews. Data were synthesized narratively across five domains: physical, psychological, emotional/social, economic, and technological alternatives. Results: Traditional plaster and fiberglass casts were consistently associated with musculoskeletal deterioration, joint stiffness, dermatological complications, and hygiene challenges. Psychological and emotional consequences included cast-induced anxiety, claustrophobia, depressive symptoms, and diminished autonomy. Social participation was frequently reduced due to mobility restrictions and perceived stigma, while economic impacts included hidden out-of-pocket expenses, caregiver burden, lost wages, and disparities in access to follow-up care. In contrast, emerging alternatives demonstrated promising advantages. LCPM systems improved ventilation, comfort, and hygiene, while reducing saw-related anxiety. Preliminary evidence suggests that both LCPM and 3D-printed systems may support improved patient experience and earlier return to selected activities, although larger comparative studies are needed to confirm effects on complication rates and long-term outcomes. Over time, these benefits may help offset higher upfront material costs. Conclusions: Fracture care should be evaluated not only by radiographic healing but also by patient-centered outcomes such as comfort, independence, and quality of life. Traditional casting imposes significant multidimensional burdens, whereas newer technologies such as LCPM and 3D-printed systems may offer a more holistic approach to immobilization while maintaining acceptable fracture stability in appropriately selected patient populations. While current evidence indicates potential physical, psychological, and economic advantages, large-scale comparative trials remain necessary to confirm long-term clinical, psychosocial, and cost-effectiveness outcomes across diverse populations. Future integration of emerging immobilization technologies into clinical practice may support more patient-centered, function-oriented, and cost-conscious approaches to fracture care. Full article

Introduction: Chronic dermatological diseases that appear in adolescence, such as acne vulgaris, atopic dermatitis, alopecia areata and psoriasis vulgaris, not only cause physical symptoms but also significantly affect young people’s quality of life, mental state, self-esteem and social relationships. Social media, especially information spread by influencers, significantly influences adolescents’ body image, health-related attitudes and even the quality of the physician-patient relationship. The aim of our study was to explore the relationships between dermatology-related quality of life, media use, health values, body image and self-esteem among adolescents with chronic dermatological diseases. Methods: In our cross-sectional, quantitative study, we used validated questionnaires (DLQI, EQ-5D-5L, IRVS, Attitude Scale, STAI-Y2, SWLS-H, Rosenberg Scale, BAT), which we supplemented with a media consumption questionnaire of our own design. Structured data collection took place between October 2024 and March 2025, with the participation of 208 adolescents aged 11–18. Data analysis was performed using SPSS 26.0 (Spearman’s correlation, Mann–Whitney test). Differences were considered significant at p < 0.05. Ethical approval: BM/22429-1/2024. Results: Acne vulgaris was the most common diagnosis (65%), followed by atopic dermatitis (22%) and psoriasis (11%). Over a quarter of the adolescents (27%) followed influencers who provided skincare advice. The mean daily screen time was 4.5 h, with 3.7 h on smartphones. A longer screen time was significantly correlated with poorer dermatological quality of life. Greater dermatology-related quality of life impairment (higher DLQI scores) was associated with poorer general quality of life (EQ-5D-5L). Following skincare-related influencers was significantly associated with dermatology-related quality of life and anxiety. Conversely, stronger health values were significantly linked to more favourable health behaviors. Conclusions: In this sample, greater dermatology-related quality-of-life impairment was associated with poorer psychosocial outcomes. Longer screen time was associated with poorer dermatology-related quality of life and less favourable psychosocial outcomes. The novelty of our study lies in the use of a self-developed media consumption questionnaire, which is suitable for the complex mapping of psychological and quality-of-life factors in adolescents. Full article

Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease characterized by diverse and evolving clinical manifestations, often resulting in delayed diagnosis and increased morbidity. Although traditionally viewed as distinct, allergic and autoimmune diseases share overlapping immunologic pathways and clinical features. Symptoms commonly encountered in allergy practice, including urticaria, angioedema, and pruritus, may represent early or coexisting manifestations of underlying lupus rather than primary allergic disease. This narrative review examines the clinical and pathophysiologic overlap between allergy and lupus, with a focus on presentations that may bring patients with undiagnosed SLE to the allergy setting. Shared mechanisms, including complement dysregulation, autoreactive IgE, and mast cell activation, are discussed as contributors to overlapping symptomatology. Key clinical features that distinguish lupus-associated presentations from primary allergic conditions are outlined, along with associated systemic findings that should prompt further evaluation. A practical approach to assessment is emphasized, including targeted history, judicious use of serologic testing, and indications for dermatologic and rheumatologic referral. Improved recognition of these patterns in allergy practice may facilitate earlier diagnosis, reduce unnecessary testing, and improve patient outcomes. Full article

Post-surgical pyoderma gangrenosum (PSPG) is a challenging diagnosis associated with significant morbidity, often misidentified as postoperative infections, leading to inappropriate management. This systematic review aims to elucidate the characteristics, management strategies, and outcomes of PSPG in the context of foot and ankle surgery to improve diagnostic accuracy and patient care. A systematic literature search was conducted across multiple databases, including PubMed, Scopus, and Embase, for cases of PSPG following foot and ankle surgery published up to January 2023. Data on demographics, clinical presentation, management, and outcomes were extracted and analyzed. Ten cases met the inclusion criteria, predominantly females presenting with rapidly worsening and painful postoperative ulcers. A high rate of negative cultures was observed during the patients’ treatment period. Dermatology consults initially suspected 83.33% of the cases. Notably, 30% of patients underwent amputation of various parts of the lower extremity, all diagnosed more than 35 days after symptom onset, and were female. The mainstream treatment for PSPG involved systemic immunosuppressants, with corticosteroids being the most common, effectively resolving symptoms in the majority of instances. PSPG should be suspected in patients with unexplained, worsening postoperative wounds. Early recognition and appropriate treatment with immunosuppressants are crucial to prevent severe outcomes. Multidisciplinary management involving dermatologists and surgeons is recommended to optimize patient outcomes. Further research is needed to establish robust diagnostic and management protocols for PSPG in the surgical context. Full article

Odontogenic cutaneous sinus tracts represent an uncommon clinical manifestation of chronic dental infection and are frequently misdiagnosed due to the absence of dental symptoms and their resemblance to dermatologic lesions. This case report describes the nonsurgical endodontic management of a cutaneous sinus tract of dental origin in a 13-year-old patient. The patient presented with a persistent extraoral lesion in the mandibular region, initially evaluated by non-dental specialists. Clinical and radiographic examination revealed a necrotic mandibular first molar associated with a periapical radiolucency and intraoral sinus tract. Nonsurgical root canal treatment was performed using chemomechanical debridement with sodium hypochlorite irrigation and calcium hydroxide as an intracanal medicament. Complete obturation was achieved following resolution of intracanal exudation. No surgical intervention of the cutaneous lesion was undertaken. Progressive healing of the periapical lesion and spontaneous resolution of the extraoral sinus tract were observed over a 6-month follow-up period. This case is noteworthy because it combines a prolonged diagnostic delay, an atypical extraoral manifestation in a child, and successful resolution by nonsurgical endodontic therapy alone without surgical excision of the cutaneous lesion. The 6-month follow-up confirms sustained clinical and radiographic healing, underscoring the importance of early recognition and conservative management in pediatric patients. Early identification and elimination of the dental source can prevent unnecessary surgical procedures and minimize the risk of permanent scarring. Full article

Background/Objectives: Insomnia is a prevalent sleep disorder with substantial public health implications, yet epidemiological data from Serbia remain limited. This study aimed to assess the prevalence of clinically significant insomnia symptoms in the adult population of Serbia and to examine associated sociodemographic, comorbidity, psychosocial, and lifestyle factors. Materials and methods: A cross-sectional study was conducted from September 2023 to September 2025, including 2577 adults aged 18–89 years across Serbia. Insomnia symptom severity was measured using the Insomnia Severity Index (ISI), with scores ≥ 15 indicating clinically significant insomnia symptoms. Sociodemographic, comorbidity, psychosocial, and lifestyle factors were assessed via self-reported questionnaires. Multivariable logistic regression with LASSO variable selection was used to identify factors independently associated with clinically significant insomnia symptoms. Results: The prevalence of clinically significant insomnia symptoms (ISI ≥ 15) was 10.9%. Independent factors associated with clinically significant insomnia symptoms included being single (OR = 1.54) or divorced (OR = 1.75), lower educational attainment (OR = 0.71 per level increase), being retired (OR = 1.83) or a student (OR = 1.66), dermatological comorbidities (OR = 2.99), use of anxiolytic medications (OR = 2.44), exposure to stressful life events (OR = 1.88), engagement in late-night activities (OR = 1.37), consumption of coffee/tea (OR = 2.22), energy drink consumption (OR = 1.52), and late-night eating habits (OR = 1.27). Conclusions: Clinically significant insomnia symptoms among adults in Serbia are influenced by a complex interplay of sociodemographic, comorbidity, psychosocial, and lifestyle factors. These findings underscore the need for integrated approaches that address both medical and modifiable behavioral determinants in the prevention and management of insomnia symptoms. Full article

Background/Objectives: Scabies is a contagious dermatological infestation that can cause not only physical symptoms but also considerable psychosocial burden. This study aimed to investigate the relationships between fear of scabies, internalized stigma, and dermatology-related quality of life in patients with scabies. Methods: This cross-sectional study included 131 patients diagnosed with scabies in a dermatology outpatient clinic. Data were collected using a structured questionnaire including sociodemographic and clinical characteristics, the Fear of Scabies Scale (FSS), the Internalized Stigma Scale (ISS), and the Dermatology Life Quality Index (DLQI). Correlation and regression analyses were conducted to examine the associations between fear of scabies, internalized stigma, and quality of life. Results: The mean DLQI score was 15.82 ± 5.69, indicating a considerable impairment in dermatology-related quality of life. Fear of scabies showed a weak but significant positive correlation with DLQI scores (r = 0.326, p < 0.001), whereas internalized stigma demonstrated a stronger correlation (r = 0.484, p < 0.001). Among the stigma subdimensions, social withdrawal showed the strongest association with impaired quality of life (r = 0.622, p < 0.001). Regression analyses revealed that internalized stigma explained 23% of the variance in DLQI scores (R² = 0.234), while fear of scabies explained 10% (R² = 0.106). In addition, longer symptom duration (β = 0.708, p < 0.001), nocturnal pruritus (β = 0.408, p = 0.009), and visible skin lesions (β = 0.263, p = 0.002) were associated with higher levels of fear of scabies. Conclusions: Internalized stigma and disease-related fear were associated with reduced quality of life, with stigma-related mechanisms appearing to play a particularly prominent role. These findings suggest that addressing stigma and providing psychosocial support may be important components of comprehensive scabies management. Full article

This study aimed to assess the risks associated with ultraviolet radiation (UVR) exposure among military outdoor workers at Lohatla Military Base, South Africa, and to inform targeted risk reduction strategies. A quantitative, cross-sectional design was employed, using a questionnaire survey with 161 participants (81% completion rate; 58.39% male; the largest age group was 19–25 years) and five days of objective environmental monitoring. Environmental data confirmed the presence of elevated solar ultraviolet radiation conditions, with peak irradiance levels recorded between 12:00 PM and 1:00 PM, while temperature highs frequently exceeded 35 °C (peaking at 39 °C). Statistical analysis using Spearman’s rank-order correlation revealed strong positive associations among sun protection behaviours, including wearing protective clothing, hat use, sunscreen use, and avoidance of peak sun exposure hours (ρ values up to 0.764, p < 0.001), indicating the clustered and interdependent nature of effective sun safety practices. Furthermore, engagement in protective behaviours was significantly associated with improved health outcomes, including a lower incidence of sunburn (ρ = 0.407, p < 0.001) and reduced hyperpigmentation (ρ = 0.438, p < 0.001). These findings indicate that combined protective strategies are associated with reduced self-reported dermatological outcomes. Despite the benefits of individual behaviours, military personnel remain exposed to high levels of environmental ultraviolet radiation, underscoring the need for institutional, evidence-based policy interventions to mitigate occupational exposure risks. The study concludes that military organisations should implement mandatory administrative controls (e.g., schedule adjustments), standardise high-ultraviolet-protection-factor protective gear, and enhance targeted health literacy training to mitigate long-term UV-related health risks and improve the operational effectiveness of their workers. Full article

Background and Clinical Significance: Cutaneous paraneoplastic phenomena are infrequently characterised in colorectal cancer (CRC), and chronic pruriginous inflammatory eruptions in particular have received limited attention. In older adults, persistent treatment-resistant dermatoses of unclear aetiology may represent overlooked extraintestinal diagnostic clues to occult malignancy, including potentially curable CRC. Faecal immunochemical testing (FIT) for occult bleeding is a low-cost, non-invasive tool whose role outside conventional alarm-symptom triage remains underexplored. Case presentation: A 72-year-old woman presented for outpatient evaluation with several months of pruriginous, pustular, and crusted symmetric eruption involving the dorsal aspects of the limbs, refractory to standard dermatologic treatment, and without gastrointestinal symptoms. A non-invasive systemic stool-based work-up demonstrated detectable faecal haemoglobin (iFOBT), mildly elevated faecal calprotectin (51.6 mg/kg, ULN 50 mg/kg), markedly elevated faecal alpha-1-antitrypsin (631 µg/mL; 2.3× ULN), and predominance of Escherichia coli on stool culture. Colonoscopy revealed a locally advanced rectal adenocarcinoma; staging classified the lesion as cT3N1M0. The patient received long-course neoadjuvant chemoradiotherapy (50 Gy, concurrent capecitabine) followed by low anterior resection with total mesorectal excision and pathological complete response (ypT0N0, R0), and adjuvant capecitabine. The cutaneous eruption resolved progressively in parallel with antineoplastic therapy without specific dermatologic intervention. The patient remains in remission at over 36 months. Conclusions: Persistent, unexplained, treatment-resistant pruriginous/pustular cutaneous eruptions may, in selected patients, coincide with an underlying malignancy, including colorectal cancer, and should prompt careful individualised clinical assessment, including review of age-appropriate colorectal cancer screening status. This single case raises the hypothesis that quantitative faecal immunochemical testing (FIT) may be prospectively evaluated as a low-cost, non-invasive triage tool in carefully selected patients aged ≥50 years with persistent dermatoses of unclear aetiology, even in the absence of gastrointestinal symptoms. Positive FIT results should be managed according to established local colorectal referral pathways. NICE diagnostics guidance DG56 supports FIT use in symptomatic adults with suspected lower gastrointestinal pathology; however, any extension of FIT to extraintestinal presentations remains investigational and requires formal validation through prospective studies assessing diagnostic yield, cost-effectiveness, and stage distribution. Full article

Background/Objectives: Erythroderma is a rare but potentially life-threatening dermatological emergency characterised by generalised erythema and scaling involving more than 80% of the total body surface area. Erythroderma is associated with significant morbidity and mortality due to systemic complications and diverse underlying aetiologies. Methods: In this narrative review, PubMed was searched up to February 2026. Studies were screened for relevance to emergency physicians, with emphasis on epidemiology, diagnostic approach, and acute management. Non-English publications and conference abstracts were excluded. A total of 122 sources were included in the final synthesis. Results: Erythroderma most commonly results from exacerbation of pre-existing inflammatory dermatoses, drug reactions, infections, or cutaneous T-cell lymphoma. Clinical presentation includes diffuse erythema and scaling affecting ≥80–90% of body surface area, often accompanied by pruritus, systemic symptoms, and signs of organ dysfunction. Systemic complications arise from cutaneous barrier failure and include fluid imbalance, thermoregulatory dysfunction, cardiovascular strain, protein loss, and secondary infection. Initial emergency department management prioritises supportive care, fluid and nutritional optimisation, restoration of skin barrier function, and assessment for organ dysfunction. While a definitive aetiological diagnosis is not always immediately required, certain conditions—particularly severe drug reactions and infectious causes such as staphylococcal scalded skin syndrome—necessitate urgent targeted intervention. Conclusions: Erythroderma represents a syndromic emergency requiring systematic evaluation and early supportive management. Prompt recognition of high-risk aetiologies and timely dermatology referral are essential to optimise outcomes and reduce morbidity and mortality. Full article

Background: Chronic kidney disease-associated pruritus (CKD-aP) is characterised as pruritus in individuals with advanced chronic kidney disease (CKD) without a discernible alternative etiology. This study assessed the prevalence, severity, and effects of CKD-aP on sleep and health-related quality of life (HRQoL) among end-stage kidney disease patients (ESKD) undergoing maintenance hemodialysis (MHD) in an Indian cohort. Methods: This cross-sectional, single-centre study included adults with renal failure undergoing MHD for ≥3 months. The primary outcome was CKD-aP prevalence and its relationship with demographic, clinical, and laboratory variables. Secondary outcomes included CKD-aP severity, characteristics, HRQoL, and sleep quality scores. Statistical analysis was conducted using SPSS v21, with a significance level of p < 0.05. Results: The 12-item Pruritus Severity Scale found mild CKD-aP to be the most common (37% of patients). The 5-D Itch Scale found that patients with moderate-to-severe CKD-aP had longer daily itching (52.9%) with a nonsignificant change over time (p = 0.18), and the back (77.9%) was the most affected site. The Dermatology Life Quality Index revealed that 75.5% of patients had HRQoL impairment. The Skindex-16 found that moderate-to-severe CKD-aP was linked to a greater symptom burden and emotional distress. The Pittsburgh Sleep Quality Index found poorer sleep quality as CKD-aP worsened. Conclusions: CKD-aP is common in patients undergoing hemodialysis and negatively impacts quality of life, emphasizing the need for routine assessment and targeted management. Full article

Background/Objectives: Post-COVID-19 condition involves heterogeneous, multisystem symptoms with uncertain recovery. We characterized symptom trajectories from hospitalization to approximately 4 weeks and to 6–8 months and compared the 6–8-month symptom burden with season-matched controls, accounting for serology-identified, previously unrecognized infections. Methods: An individually pair-matched case–control study of adults with RT-PCR–confirmed SARS-CoV-2 and population controls from the Bialystok PLUS cohort, matched on age, sex and a two-month visit window, was performed. All participants underwent anti-nucleocapsid serology. Hospitalized cases were reassessed at approximately 4 weeks and 6–8 months. Cross-sectional outcomes used non-parametric tests and multivariable regression; longitudinal change used paired tests and generalized estimating equations. Results: We included 402 adults (201 post-COVID-19; 201 controls). In hospitalized cases, respiratory symptoms declined rapidly by approximately 4 weeks and remained low at 6–8 months; smell/taste recovered more slowly; fatigue improved modestly; anxiety changed minimally. At 6–8 months, total symptom counts were higher in post-COVID-19 than in controls (median 4 vs. 2), with serology-positive controls intermediate (median 3). Excess burden was concentrated in non-respiratory domains (fatigue, neurocognitive, cardiovascular, and dermatologic), whereas respiratory differences were not significant. In the multivariable model, female sex remained an independent predictor of higher multisystem burden, whereas age, body mass index, hospitalization, and acute biomarker severity were not associated. Conclusions: Six to eight months after symptomatic COVID-19, multisystem symptom burden remains substantial relative to season-matched controls, despite substantial resolution of respiratory complaints. Serology-based identification of previously unrecognized infections indicates an intermediate burden and can guide targeted follow-up. Full article