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Skin Rashes Reported in COVID 19 Pandemic

May 8, 2020


It is well known that the novel coronavirus at the center of the COVID-19 pandemic affects people differently. In fact, those infected by the virus have experienced a wide range of symptoms and outcomes. Symptoms can range from none in people who are asymptomatic to fatal outcomes in patients with severe breathing difficulty and pneumonia. According to the Centers for Disease Control & Prevention, a dry cough, shortness of breath, fever, chills, muscle pain, headache, a sudden loss of taste or smell, and sore throat may appear in adults or children within 2 to 14 days after exposure to the virus. According to the World Health Organization, older adults and persons with pre-existing medical conditions or compromised immune systems are at a higher risk for severe illness from the virus. This vulnerable group includes people who have heart disease, lung disease, cancer, high blood pressure, or diabetes. With doctors around the world being pulled from their usual practice of medicine to help with the overflow of hospitalized patients, dermatologists have globally started to share information on skin rashes seen in COVID-19 patients.

IMPORTANT NOTICE: If you are suffering with two or more of the published symptoms (see COVID-19 Self Checker), you should follow your local instructions for COVID-19 testing rather than book an appointment with your dermatologist. The skin rashes discussed in this article have not been included as qualifying symptoms for diagnosis or treatment of the viral infection.

“It is not surprising that skin manifestations are being reported in cases of COVID-19,” said Dr. Michael Steppie, President and Medical Director of Associates in Dermatology. “Anyone who has suffered with measles or chicken pox are aware of the painful rash and blisters that can accompany a viral infection. However, it is unlikely rashes will have a practical use for diagnosing the disease as more obvious symptoms exist.” The doctors, nurse practitioners and physician assistants at Associates in Dermatology, want to stress the importance of routine skin checkups for managing your overall health and wellness. There are dozens of skin conditions associated with a broad spectrum of diseases that have similar underlying symptoms. If you or a family member have a dermatologic issue while sheltering in place, visit our COVID-19 policy page for current information.

Associates in Dermatology is available to see patients following the strict sanitation protocols mandated by state health officials. Click to schedule or reschedule an appointment at one of our offices during the outbreak of coronavirus. Also, most of our dedicated dermatology providers are available for a tele-medicine visit.

Documented Coronavirus Skin Manifestations

Although the term “covid-19 skin rashes” has become a popular search query online, it is too early to say whether the rashes are related to the coronavirus or other factors like a side effect of medications. Since this viral disease can impact almost every organ and system in the human body (including the skin), the medical community has been excited by the global documentation of symptoms presented.  So far, COVID-19 skin rashes seem as different as the affects the disease has from one patient to the next.

Listed below are six of the reported manifestations* to the body’s largest organ including:

Urticaria
This common skin rash, also known as hives or nettle rash, is an outbreak of red bumps or skin plaques that can be triggered by many things including medications or infections.

Morbilliform
Morbilliform resembles measles and usually consists of macular lesions or maculopapular skin eruptions. In addition to being seen in viral infections, drug reactions due to hypersensitivity have occurred in patients taking antiretroviral and antiepileptic drugs.

Livedo Reticularis
Livedo reticularis is a vascular condition characterized by mottled, purplish discoloration of the skin that often appears on the patient’s legs forming netlike patterns.

Acral Ischemia
Like other skin manifestations, this chicken pox-like rash may be associated with a viral infection. A rash on the toes that appears as raised, purplish lesions that resemble frostbite have been dubbed “COVID Toes”.

Petechial
Petechiae is bright red, pinpoint rash commonly seen in other diseases and is caused by bleeding under the skin. In certain areas of the world, it can easily be mistaken for the onset of dengue fever.

Vesicular
If a rash appears in the same place as multiple vesicles with fluid trapped under the top layer of skin, it is diagnosed as a vesicular rash. Itchy, painful blisters can consolidate into larger single vesicles.

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

It is difficult to determine the exact relationship of skin signs to the active coronavirus since widespread testing is not currently available. As more evidence is disseminated regarding all types of skin manifestations, researchers will be able to determine the causality, frequency and meaning of the numerous rashes being observed during the COVID-19 pandemic.

American Academy of Dermatology Launches COVID-19 Registry

With massive amounts of medical data being shared throughout the global village, the additional dermatological research should continue at an accelerated pace. The American Academy of Dermatology recently launched the COVID-19 Dermatology Registry for healthcare professionals and will be at the forefront providing guidance to doctors as more is understood about this novel viral infection. Observations suggest some reported skin manifestations so closely resembled common viral infections that, without proper COVID-19 testing, an early diagnosis was nearly impossible. Nonetheless, the clinical occurrence of these skin manifestations can be considered in support of other diagnostic evidence to recommend people to be tested.

 

Disclaimer: If you have an unexplained skin rash with any of the CDC’s COVID-19 symptoms, do not make an appointment with your dermatologist, instead you should follow the instructions published for local COVID-19 testing, so you can be triaged for the correct level of medical attention and care.

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