While the three most common symptoms of Covid-19 are cough, high temperature/fever and loss of smell and taste and are universally know, few know that rashes on skin are also indicative of suffering from novel coronavirus. A report published in The Lancet journal reported that skin lesions such as erythematous rashes, urticaria and chicken pox-like vesicles “developed at the onset of SARS-CoV-2 infection or during hospital stay and did not correlate with disease severity.”
Some of the lesions also had burning and itching while some began as erythematous-violaceous patches that slowly evolved to purpuric lesions and then to blisters and ulceronecrotic lesions, with final complete return to normal. Another research found that 21% of the Covid-19 patients they observed, reported skin rashes as their only symptom while 17% of patients suffering from coronavirus experienced rashes as their first symptom.
A study published online ahead of print in the Journal of the American Academy of Dermatology found that Covid-19 does not cause one particular rash but rather it’s causing a variety of rashes. In view of other studies conducted across the world, four types of skin changes were found to be catalogued in the broad spectrum of dermatologic manifestations associated with coronavirus infections or associated with locating Covid-19:
1. Skin lesions:
In A Review of the Dermatological Manifestations of Coronavirus Disease 2019 (Covid-19), the frequency of the skin lesions associated with Covid-19 infection was revealed to vary according to the series. In another Spanish study including 20 children and adolescents with acral lesions, four clinical patterns were described: acral erythema (30%) dactylitis (20%), purpuric maculopapules (35%), and mixed pattern (15%).
Sanchez et al. reported a skin eruption similar to that of pityriasis rosea and described a new clinical presentation of skin lesions associated with Covid-19. They were found to develop in the trunk, upper arms and periumbilical.
2. Blisters or vesicular lesions
A blister or a vesicular lesion is an area of skin covered by a raised and fluid-filled bubble and though a Spanish study reported symptoms of such skin problems among many Covid-19 patients, blisters must not be considered as one of the determining factors of coronavirus infection. Some Covid-19 patients may even experience ulceration or blistering in their oral cavity.
However, water blisters or small fluid-filled micro-blisters often appear on the hands and are commonly suffered by middle‐aged Covid-19 patients. These blisters are associated with medium-severity disease and last only for over ten days.
3. Covid toes or chilblains
Sometimes as small blisters or as pustules, these chilblain-like lesions or ‘Covid toes’ as they are commonly called, appear late in the disease. Most common in children, they can affect hands or feet or both at the same time but are also reported in adolescents and young adults with no or only mild symptoms of Covid-19, the red-purple discoloured skin being painful and itchy.
Researchers at Massachusetts General Hospital (MGH) and Harvard Medical School (HMS), in collaboration with the American Academy of Dermatology and International League of Dermatologic Societies found that Covid toes or chilblains consist of “red or purple itchy or tender bumps on the toes, heels or fingers, typically seen when skin is exposed to cold air or surfaces.”
4. Urticaria or hives
These may appear as blotches or raised red lumps (wheals) and are itchy skin rashes that are usually red, pink or flesh-coloured. Though hives mostly clear within ten days, they are associated with more severe disease in all ages.
Hives range from the size of a pinhead to a dinner plate and may come and go even if the swellings caused by them in one spot, disappear within minutes or hours.
If you develop any of these or other skin changes, consult a dermatologist immediately via a telehealth appointment as you might be infectious. In case you do have a rash that’s unusual or might fit one of these categories, it is important to be aware of it and get tested for Covid-19 and self-isolate until you receive your test results.