Covid-19-induced skin rashes: what you should look out for
Covid-19-induced skin rashes: what you should look out for
Viruses are responsible for many common infections in children such as chickenpox and rubella. In many of these cases, in addition to a fever, general maliaise and headaches, the infection can produce a skin rash, called a “exanthem” as can be seen here.1 Since COVID-19 is also caused by a virus, it is perhaps not surprising that skin rashes might occur in those who are infected. Early information from Wuhan, China, suggested that patients with COVID-19 could see changes in their skin but it wasn’t until April that a study from Spain2 found that in a group of 375 patients with COVID-19, many of them developed a skin rash.
Towards the end of March in the UK, a team of researchers from Kings College, London began collecting information on COVID-19 symptoms as part of a COVID symptom study. Patients registered with the study app and self-reported their symptoms on a daily basis. By July, it became very clear to the team that skin rashes were a very commonly reported problem. In fact, the researchers went further and called for skin rashes to be added to the list of recognised COVID-19 symptoms.3 They published4 their findings which showed that 8% of those who tested positive for COVID-19 had a skin rash and interestingly, a rash was the only symptom in 21% of those who later tested positive.
So what are the most frequent skin changes seen in someone who has COVID-19 and what do they look like? Below is a description of the more common rashes seen and the links can be used to see images of the conditions.
Urticaria (e.g., hives or a nettle rash)
This type of rash seems to occur early on in the infection, normally appearing on the body and it can be quite itchy. Urticaria typically comes and goes quickly over a few hours but it is important to be aware that if it spreads to the lips, check that someone doesn’t also have any problems breathing as this will need urgent medical attention. The rash can be treated with antihistamine tablets.
Erythemato-papular or vesicular rash (e.g. prickly heat or chicken-pox like)
These are two types of rash that have been found. An erythemato-papular rash is the medical name for a red, bumpy rash which looks like prickly heat. An erythemato-vesicular rash, resembles chicken pox and both types of rash are often very itchy and can last for a days and even weeks. The rash can appear anywhere on the body but has been found to occur on the elbows and knees as well as the backs of the hands and feet.
This is thought to be the most likely skin rash to be caused by COVID-19. Skin specialists started to notice red or purplish bumps on the fingers and toes which resembled chilblains, which are a harmless but painful inflammation of small blood pressures in response to cold air during the winter months. However, it was unsual that these changes appeared in the warmer springtime weather and especially as the changes were more common in younger people.
Finally, some patients have developed score, dry lips5 and the inside of the mouth can also seem dry. Although skin rashes can have many different causes, if someone develops any of the above changes, especially COVID fingers and toes and other classic COVID-19 symptoms, then they should consider getting tested for the virus.
About the author
Rod Tucker is a pharmacist with over 30 years’ experience and is currently an independent researcher and writer focusing on dermatology.
References
1 Exanthems. DermNet NZ. Accessible at: https://dermnetnz.org/topics/exanthems/ Last accessed: 30th Nov 2020
2 Galvan Casas C. et al. Classification of the cutaneous manifestations of COVID‐19: a rapid prospective nationwide consensus study in Spain with 375 cases. British Journal of Dermatology. 29 April 2020. Accessible at: https://doi.org/10.1111/bjd.19163 Last accessed: 30th Nov 2020
3 COVID Symptom Study. Skin rash should be considered as a fourth key sign of COVID-19. September 14 2020. Accessible at: https://covid.joinzoe.com/us-post/skin-rash-covid Last accessed: 30th Nov 2020
4 Visconti A et al. Diagnostic value of cutaneous manifestation of SARS-CoV-2 infection. medRxiv. Oct 26 2020. Accessible at: https://doi.org/10.1101/2020.07.10.20150656 Last accessed: 30th Nov 2020
5 British Association of Dermatoliogists. Covid-19 Skin Conditions > Oral. Accessible at: https://covidskinsigns.com/tag/oral Last accessed: 30th Nov 2020
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