LIVE

One study found that a rash was the only symptom of COVID for 21% of patients.

By Colleen Murphy
March 18, 2021
Advertisement

In the beginning days of the pandemic, there was focus on three main signs of COVID-19: fever, cough, and shortness of breath. But as experts began to better understand the disease, it became clear that there are many health changes that could indicate someone has the virus—new loss of taste or smell, diarrhea, and headache just to name a few. Currently, the Centers for Disease Control and Prevention (CDC) lists more than 10 symptoms that may signal a COVID-19 infection. The list is not exhaustive, though, and the CDC says it will continue to update the list as they learn more about the disease.

One such potential sign of COVID-19 that isn't included on the list is skin rashes.

COVID-Rashes-GettyImages-136359824
Credit: Getty Images

According to a recent study published in the British Journal of Dermatology, there is significant association between skin rashes and a positive COVID-19 swab test result. Researchers made that determination by looking at information from 336,847 people in the UK who had uploaded their health history, including any COVID-19 test results and symptoms, to the COVID Symptom Study app. The app data showed that, among those who had a positive swab test result, 8.8% also reported skin rashes.

To better understand the length and timing of these skin symptoms, the researchers then looked at the results of an independent survey on skin symptoms related to COVID-19 that 11,544 people had completed.

The skin changes appeared at the same time as other COVID‐19 symptoms for 47% of the survey respondents and after other COVID-19 symptoms for 35% of the survey respondents. But what the researchers found to be most striking was that 17% of the respondents said that their the skin changes happened before any other COVID-19 symptoms. And 21% of the people said that their rash was the only symptom of COVID-19 they experienced.

The researcher say that their "study strongly supports the inclusion of skin rashes in the list of suspicious COVID‐19 symptoms." And while rashes might be less common than other signs of COVID-19, the study authors point out that skin changes can be easily recognized, which may help with virus detection and contact tracing.

To help people identify what a COVID-19 rash might look like, and using the pictures that the survey respondents had submitted, the researchers worked with the British Association of Dermatologists (BAD) to create a catalogue of images of the most common skin manifestations of COVID‐19. The rash pictures are divided into these main categories:

COVID digits

According to the BAD, since they don't really look like any other skin condition, COVID toes and fingers—aka digits—might be the most telltale COVID rash.

Technically known as chilblains, the condition is typically seen more during the colder months, so when dermatologists started seeing more cases of the condition in warmer months, at the start of the pandemic, many took note, and the link with COVID-19 was eventually made.

"The rash appears as reddish and purplish bumps on the fingers or toes and can affect many digits," per the BAD. "The fingers and toes are usually sore, but not itchy." As the rash heals, the top layers of skin may peel away from where the purplish bumps were, leaving scaly patches.

Dermatologist Veronique Bataille, MD, PhD, and researcher Mario Falchi, PhD—two of the study's lead authors whose work helped build the image catalogue—tell Health that COVID digits can happen months after the original infection and are more common in young people who may have been asymptomatic.

Neck & exposed chest eczema

This rash appears on the neck and on the part of the chest that is exposed to sunlight. Usually, the rash is pink and itchy. It can appear at any time during or after the infection and typically lasts for an extended period of time. And according to Dr. Bataille, a patient doesn't have to have a history of eczema for this type of rash to develop. In fact, most patients included in the survey had no history of skin conditions.

Oral rash

With this rash, a person's lips may feel sore. As the rash subsides, the lips can become dry and scaly. The BAD reports that soreness inside the mouth can also occur.

Papular & vesicular rashes

These rashes occur around papular lesions (solid, raised bumps) or vesicles (bumps filled with fluid). A rash like this can pop up anywhere on the body, but it usually develops on the elbows and knees, as well as on the back of the hands and feet. Heat rashes, for example, are a type of vesicular rash.

Sometimes, papular and vesicular rashes aren't so easily identifiable. "In some cases, it is only tiny bumps all over the skin, and the signs may be more subtle," per the BAD. In general, the rashes are usually "very itchy." In COVID-19 patients, papular and vesicular rashes can last long after the contagious stage is over and may also appear many weeks after the onset of the infection.

Pityriasis rosea

According to the Mayo Clinic, pityriasis rosea is a rash that usually begins as a large circular or oval spot on your chest, abdomen, or back. Called a "herald patch," this spot can be up to 4 inches wide. "The herald patch is typically followed by smaller spots that sweep out from the middle of your body in a shape that resembles drooping pine-tree branches," the Mayo Clinic reports. The BAD says the rash can last several months before clearing.

Purpuric or vasculitic rashes

Purpura is a term used to describe the purplish discoloration of the skin caused by bleeding into the skin. So "purpuric" is the adjective used to describe this type of rash. "Vasculitic" has to do with blood vessels. These rashes show as multiple deep red or purplish spots and can cause bruise-like patches. According to the BAD, "these spots and patches are caused by damage in the superficial tiny blood vessels with bleeding into the skin."

Urticarial rash

Hives—aka urticaria—can also be a sign of COVID-19. This rash appears suddenly and, over the hours, quickly comes and goes. Usually, the hives are "intensely itchy." Any part of the body can be affected, including the face. "Urticarial rashes can present quite early in the infection but can also last a long time later when the affected person is no longer contagious," the BAD reports.

Viral exanthem

As Connecticut-based dermatologist Mona Gohara, MD, previously told Health, "it's not unique that a virus would give you a skin rash." In fact, viral exanthem (exanthem meaning widespread) is a common rash seen on patients with viral infections. It is a symmetrical rash with numerous reddish blotches or bumps over the body. And, according to the BAD, it usually goes hand-in-hand with other symptoms of a viral illness, such as fever and cough.

And while COVID-19 isn't the only viral infection to affect the skin, Dr. Bataille and Falchi do say that, compared to other viral infections, the rashes with COVID-19 seem to be more common and more diverse. 

Though not specifically included as a main category in the BAD's image catalogue, livedo reticularis has also been identified as a possible sign of COVID-19. "Livedo" refers to the skin's discoloration, and "reticularis" refers to the rash's netlike pattern. It looks like this:

Usually, this type of rash is one that lasts a long time—sometimes, it's even permanent. But as Health previously reported, dermatologists are seeing transient livedo reticularis in patients with COVID-19, meaning the rash comes and goes. The rash presents itself as tiny purple, red, or brown spots that one may mistake for bruising under the skin.

According to Dr. Bataille and Falchi, the rashes that may be associated with COVID-19 have no long-term effects, with most clearing up. "However, for some, the rashes are quite recurrent and can come and go for weeks and months. Some of the rashes can be very itchy and affect sleep, so there may be a need a prescription from a doctor," they say.

People who think they're having skin symptoms of COVID-19 should wear a mask, quarantine if they are otherwise well, and arrange a telehealth appointment with their health care provider to address their symptoms, according to Mary Stevenson, MD, assistant professor of dermatology at NYU Langone Health.

"Your dermatologist can help you with your skin by suggesting treatments for any painful lesions, but stay safe and call them or arrange a visit virtually," she tells Health. "If you have other symptoms like respiratory issues or extensive skin lesions, you need to be triaged either virtually or in person. You should also get tested [for COVID]." 

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 CDCWHO, and their local public health department as resources.

To get our top stories delivered to your inbox, sign up for the Healthy Living newsletter.