Latest Information on COVID-related Skin Conditions

March 15, 2022

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As the world awaits the end of the pandemic phase in dealing with coronavirus, it is a good time to look forward and develop a better understanding as to how each person can best manage his or her health during an endemic. Michael Steppie, Orlando Dermatologist and Medical Director of Associates in Dermatology reported on skin rashes related to coronavirus infections back in May of 2020 in this website's blog titled: “Skin Rashes Reported in COVID 19 Pandemic”.

The purpose of this blog is to update family members in the seventeen Central Florida communities that we serve about medical conditions, especially skin manifestations, that have changed or developed over the past two years of living with coronavirus as it has morphed and mutated into challenging new variants. Additionally, we have provided links to very credible sources of information on preventative steps to take and how to track COVID variants at the community level.

Early on dermatologists around the world were sharing their observations of several skin conditions that had been noticed in patients suffering from COVID-19 (the original variant). Since that time, medical researchers have compiled considerable data and have even made note of skin conditions that are more prevalent with each specific variant, such as Delta or Omicron types of the coronavirus.

Injection Site Rashes, Lip Sores, and Hives

Although most people do not experience side effects from a COVID vaccination, the list of adverse reactions includes pain, swelling, and redness at the injection site. According to the Centers for Disease Control and Prevention, if you have a red, itchy, swollen, or painful rash at the spot where you got a COVID vaccination, this is a normal occurrence and is not considered to be a severe allergic reaction. You may want to take an antihistamine and/or acetaminophen, but you should still get other shots and a booster at recommended intervals. If you experience a severe allergic reaction to a vaccine, such as difficulty breathing, a drop in blood pressure, swelling of the throat or tongue, or a generalized outbreak of hives, then seek immediate medical attention by calling 911.

Facial rashes involving the eyelids and cheeks have routinely been noticed with coronavirus infections. Currently, as the dominant global variant Omicron continues to circulate globally, people are presenting with pale blue-tinge nail beds and scaly lips. A rash, sores or ulcers may appear on the lips or in the mouth that normally settle after a couple of weeks. If you have severe oral lesions in the mouth, you should see a doctor or dentist. Rinsing with a prescription mouthwash can help to better manage your discomfort. Oral symptoms are definitely not new, since the onset of the original COVID variant, people have complained about a loss or altered sense of taste that often last long after other symptoms disappear.  

Mask Acne and Other Skin Irritations

Hopefully wearing a mask will become a thing of the past for most of us, but not for everyone. "Masks will always be an important tool for preventing the spread of disease for health care workers and those who are immune-compromised," remarked Michael Steppie. "For those with a special need, wearing a mask can trigger an unwanted skin condition." According to the University Hospitals newsletter, more than one-third of frontline health care workers report adverse skin reactions after wearing N95 masks daily for several months. In addition, contact dermatitis and transcutaneous absorption of potential carcinogens can occur from textiles used in unregulated fabric masks. Your skin microbiome also can be influenced by several external factors that are modified with routine mask wearing.

An article in the Journal of the American Academy of Dermatology about “maskne” reported on a higher incidence of conditions including mask acne, facial itch, and red rashes. If you have a red sore rash, a worsening of rosacea, soreness behind your ears, or contact acne, you should make an appointment with a dermatologist to ensure there are no secondary infections. For the most part, these problems are not caused by any allergic reaction to the mask itself, but may be the by-product of wearing fragrances, makeup, friction, oily skin, or even the high-level of humidity that is common in Central Florida. But, as a consideration for daily skincare, you might include using antibacterial cleansers and moisturizers formulated as a prescription emollient. When you can, it is a good idea to alternate mask types and remember that masks should be worn for the shortest interval possible.

Documented Coronavirus Skin Manifestations

“Anyone who has suffered with measles or chicken pox is aware of the painful rash and blisters that can accompany a viral infection,” remarked Dr. Steppie. “From day one healthcare providers have been reporting a broad range of skin manifestations, whereas some are directly related to the viral infection, many of these are commonly seen with other medical conditions.”

Skin plagues, hive-like rashes, oral sores, maculopapular eruptions, pityriasis rosea, covid toes, and vesicular blisters are commonly seen in normal times, so it is not surprising that these manifestations are symptoms linked to the COVID virus. Listed below are examples of skin manifestations and new rashes that are still being seen in patients suffering from coronavirus variants:

*Photo stock images of skin rashes (not actual COVID-19 patients).

It is difficult to determine the exact relationship of skin manifestations to an active coronavirus variant, but numerous rashes and other medical conditions are still being observed as we move into the endemic phase.

Rise of the Stealth Omicron Variant

As communities in Central Florida continue to move towards normalcy and cases of the disease are seeing an all-time low, there is always the threat of a new variant. Every virus mutates at one point or another, and it is this mutation that allows new variants to be formed. “This can be confusing for the general population as variants can split into sub-variants,” says Dr. Steppie. “In fact, the Delta variant of coronavirus has more than 200 sub variants.” Researchers believe that the rapid onset of the Omicron variant was related to the large number of people who had immunity to the Delta variant. Studies have already shown how a new sub variant dodges the body’s immunity from a previous infection or series of vaccinations to continue its spread.

Stealth Omicron or Omicron BA.2 variant that was first detected in Europe has since made its way around the world to become the leading strain of coronavirus infections aboard. Although more scientific data is still needed as to whether Stealth Omicron can lead to a more serious case of the disease, there are indications that it is very likely more transmissible. Both good and bad news were reported from a recent Danish study on BA.2. The bad news is people with a natural immunity from an infection of the original Delta variant were four times more likely to catch the stealth version. On the other hand, the good news was that anyone infected with the original Omicron strain as well as fully vaccinated individuals seemed to be well protected from the latest strain.

How to Track COVID Variants in Your Community

New variants and sub variants of coronavirus (SARS-CoV-2) are expected to continue to emerge and disappear, while others will likely replace existing strains in order to continue the spread. The Centers for Disease Control and Prevention (CDC) and other public health organizations closely monitor all coronavirus variants in the United States and globally. You can keep up with the spread of COVID as well as the variants of concern at the CDC website and learn more about the tools being used in the ongoing fight to manage the viral infection as an endemic occurrence. If you would like more information about circulating variants in your community, use the CDC Nowcast tool and enter your state and county for recommended steps for prevention to protect yourself and your loved ones.

High levels of vaccination and immunity from infections have greatly reduced the risk of medically significant disease, hospitalization, and death for most people. Nonetheless, the bottom line is the Omicron variant continues to spread causing a number of different symptoms that you can’t always anticipate. Since dozens of skin conditions associated with a broad spectrum of diseases can present with similar underlying symptoms, the doctors, nurse practitioners, and physician assistants at Associates in Dermatology stress the importance of resuming your health checks to better manage your overall wellness. Click to schedule an appointment for any skin, hair, and nail condition at one of our seventeen (17) convenient locations serving communities throughout Central Florida.

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COVID Risk Factors: According to the World Health Organization and the Centers for Disease Control and Prevention, older adults and persons with pre-existing medical conditions or compromised immune systems are at a higher risk for severe illness from the virus. These vulnerable groups include people who have heart disease, lung disease, cancer, high blood pressure, diabetes, and HIV. If you or a loved one fall into a high-risk category, get vaccinated, stay up to date on your COVID boosters, and minimize exposure when in public by maintaining distance and wearing a mask. Every man, woman, and child should continue to wash their hands, use hand sanitizer that contains at least 60% alcohol, and avoid touching your eyes, nose, and mouth.