Does Coronavirus Cause a Rash? What You Need to Know

After a doctor shared images of a potentially coronavirus-induced skin rash, Health investigated.

During the incessant coronavirus-induced hand washing, it was normal to get a mild rash on your hands. But rashes that came and suddenly disappeared? Not so normal.

Randy Jacobs, MD, a California-based dermatologist, observed cases of a mystery rash early in the pandemic in three of his patients diagnosed with COVID-19. What was so unique about this rash was that it appeared to come and go, unlike other rashes typically associated with a viral infection like chickenpox, measles, or even dengue fever.

"What we're seeing is transient livedo reticularis, a dermatological diagnosis that's usually autoimmune related, and it looks exactly like what this photo shows," said Dr. Jacobs, whose article on the findings was published in the April 10, 2020 issue of the Journal of the American Academy of Dermatology. "Normal livedo reticularis usually lasts a long time, sometimes it's even permanent. It's not something that comes and goes," said Dr. Jacobs.

Lara Devgan, MD, a New York-based board-certified plastic surgeon, shared photos of Dr. Jacobs' findings on her Instagram profile after seeing the images circulate in a private doctors' Facebook group, garnering over 100 comments from concerned doctors and patients. "One thing that has been very remarkable, especially in private physician social media groups and Listservs, is that there's a vast amount of information being shared very rapidly, and really helping to improve our algorithm in treating and managing coronavirus," Dr. Devgan told Health. "Coronavirus is a disease entity where our knowledge is rapidly evolving and we're building the ship as we sail it," Dr. Devgan added.

The rash presents itself as tiny purple, red, or brown spots that one may mistake for bruising under the skin.

In Italy, where the coronavirus cases peaked in March 2020, a small observational study of 88 patients showed that 20.4% of them developed some form of skin condition speculated to be related to COVID-19. "There is a possibility that a COVID-19 patient might initially present with a skin rash that can be misdiagnosed as another common disease," reported Beuy Joob, PhD, of the Sanitation1 Medical Academic Center in Bangkok, who co-authored another 2020 study investigating a COVID-19-related rash.

"It's not unique that a virus would give you a skin rash," Mona Gohara, MD, a Connecticut-based dermatologist told Health. "[Dr. Jacobs] may have identified a unique pattern that could be associated with COVID-19."

Could a Mouth Rash Be a Sign of Coronavirus?

Researchers in Spain reported yet another type of rash, this one found in the mouths of hospital patients with COVID-19 and skin rashes. Of the 21 people in the study, six (or 29%) had an "enanthem" rash, meaning inside the body, specifically in their mouths. Four of the six were women. The rashes appeared, on average, just over 12 days from the onset of their COVID-19 symptoms. Five of them developed a type of rash that looked like tiny spots, called petechiae.

Reporting in the July 15, 2020 issue of JAMA Dermatology, the authors said the presence of a mouth rash, and petechiae, in particular, suggested that the cause may be a viral infection, as opposed to an adverse drug reaction. Of course, one small observational study does not prove cause and effect. Much more research is needed. But it's another potential clue, one that may have been largely overlooked because, due to safety concerns, "many patients with suspected or confirmed COVID-19 do not have their oral cavity examined," the authors pointed out.

Is COVID-19 Causing my Skin Rash?

So what causes a skin rash? Usually, some skin irritation or exposure to an allergen can result in a skin rash that itches like eczema, which would be pretty common if you were frequently washing your hands.

In this unique case, this itch-free rash could be caused by your immune system's response to the virus. "If [the rash] is transient (coming and going), what we suspect is that a bunch of viral particles are being released into the bloodstream at that particular moment," Dr. Jacobs told Health. "The rash itself is caused by a blockage of blood called vaso-occlusion. When you block the blood, you don't get oxygen."

Rachel Nazarian, MD, a New York-based dermatologist and a fellow of the American Academy of Dermatology, attributed these rash patterns to poor circulation in relation to COVID-19, given that many patients were dealing with heart issues associated with the disease. "What we're finding could essentially be little baby strokes due to decreased blood circulation, related to COVID-19's ability to possibly increase the blood to clot." Dr. Nazarian had also noticed these patterns in three of her patients, all of whom were considered relatively young and healthy.

According to the Centers for Disease Control and Prevention (CDC), "dermatologic manifestations may be associated with COVID-19". The CDC also states that "while the frequency remains unknown, reports have ranged from 0.2% early in the pandemic, to as high as 20.4%." The CDC notes that the American Academy of Dermatology has a picture file of various rashes that may be related to COVID-19.

So what should you do if you encounter this specific rash? With any kind of chronic rash, always talk to your dermatologist to determine a potential course of treatment, one that may lead to COVID-19 testing. "There are doctors looking into how common this rash is," said Dr. Jacobs, "because a lot of people might not even notice it, especially if you're wearing pants all day."

The information in this story is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. While Health is trying to keep our stories as up-to-date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using the CDC, WHO, and their local public health department as resources.

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