Is my skin rash a COVID-19 symptom?
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June 17, 2020
Reports that first came from China and then from Europe have shown that the skin can be affected by SARS-COV-2 (the virus that causes COVID-19) in up to 20% of cases. The virus triggers a number of immune reactions so it is no surprise that the skin is involved. The issue is that COVID can cause a wide variety of skin signs and symptoms, which is why there has been a delay in recognising that these various skin rashes were linked to the virus.
In this blog we will focus on the three main types of skin rashes associated with COVID: urticaria (hives), erythemato-papular rash (described as a red bumpy rash) or erythemato-vesicular rash (described as chicken pox-like rash), and chilblains.
These rashes can present quite early on in the infection, but can also last a long time after, when the patient is no longer contagious. The rash appears as sudden raised wheals on the skin which come and go quite quickly over hours and are usually very itchy. It can involve any part of the body. If it affects the face, it can cause swelling of the lips and eyelids. The eruption can also start with intense itching of the palms or soles. It is usually treated with antihistamines. If the patient has lip swelling, it is important to check that there is no difficulty in breathing or wheezing as this would need urgent medical attention.
Figure 1: Acute urticaria caused by COVID with itchy wheals all over the body.
Fig 2: Swollen lip caused by urticaria-type reaction in individual with COVID-19 infection.
Erythemato-papular or erythemato-vesicular rash
An erythemato-papular rash (described as a red bumpy rash) or erythemato-vesicular rash (described as chicken pox-like rash) rash is different from urticaria as it persists for days or weeks. It appears as red and bumpy areas which may occur anywhere on the body, but favours the elbows and knees as well as the back of the hands and feet. It can resemble bad prickly heat. In some cases, it is only tiny bumps all over the skin and the signs may be more subtle. This is also usually very itchy. The rash can also last well after the contagious stage is over and may also appear many weeks after the onset of the infection.
Fig 3. A bumpy and itchy rash on the upper back which some crusted areas where some small vesicles (blisters) were present.
Fig 4: Rashes on the back of the feet or hands are common with COVID and may look like prickly heat. It is also common on the elbows and knees.
COVID fingers and toes
This is the most specific COVID rash as not many other skin conditions present in this way. It is known as chilblains and was relatively rare before COVID as it was seen mainly during cold spells and in people who had some problems with circulation in the fingers or toes. At the outset of COVID, however, dermatologists started to notice this type of rash much more than normal and in warm weather which seemed very unusual.
Eventually the link with COVID was made and this rash tends to be more common in younger people. The rash presents itself as reddish and purplish bumps on the fingers or toes and can affect many digits. This type of rash is usually present later in the infection and again may appear weeks after the onset of the viral infection. The fingers and toes are usually sore, but not itchy. When the rash recovers, the top layers of the skin may peel where the purplish bumps were.
Fig 5: Purplish raised areas on the fingers is quite a specific rash for COVID and is usually painful.
Fig 6: It can also cause multiple red and sore bumps on many fingers and it may be difficult to type.
Fig 7: Purplish-red bumps and blisters are seen on the 3rd and 4th toes.
Eyes, lips and mouth
COVID can also cause sore and watery eyes. The lips may also feel sore and may be dry and scaly when they recover. Soreness inside the mouth can also occur.
Fig 8: Sore lips with some whitish areas and scaling (also called cheilitis) can be caused by COVID.