More and more reports in the scientific literature are being published about skin signs that are being seen in people infected with COVID-19.

One study in Italy reported that skin rashes were seen in up to 20% of patients with COVID-19. In some cases, skin signs have been the only reason a person has been tested for COVID-19.

There are many different skin rashes that are emerging as signs of possible COVID-19 infection. Skin rashes are probably caused by many different things like very small blood clots in small arteries in the skin, but other theories about other clotting issues during infection have also been blamed. Our understanding of this virus and exactly how it affects all organs, including the skin, is evolving day by day. Some studies suggest some skin signs are a result of tiny blood clots in the arteries in the skin, others suggest the infection causes inflammation of the blood vessel wall. Other reactions on the skin are typical of what we see with other common viruses.

What are the skin things you need to know about and look out for in the time of COVID-19?

1. “COVID Toes”
“COVID toes” is a term referring to red-purple painful or burning spots or lumps on the toes that look a lot like chilblains. The spots may develop blisters on them too. COVID toes have been reported in people who have had no other symptoms at all of COVID-19 (which is called asymptomatic) or who have mild symptoms of COVID-19. Fingers can also be affected. COVID toes usually resolve in a few weeks. In those with skin of colour, these spots may just look like brown or purple-ish spots or lumps.

2. Hives
Hives (or urticaria) is a common rash that causes itchy, swollen/raised red spots on the body. It may appear before the other symptoms of COVID-19 develop (like cough, fever etc). These spots come and go within 24 hours and don’t leave any scars on the skin. It can result as a reaction to any viral illness (there are non-viral causes too) but has also been reported in COVID-19 positive patients.

3. Fishing-net rash on the legs
Livedo reticularis is a fancy name for a rash that results in a pattern on the skin that looks like lace or a fishing-net. The red to purple-ish discolouration on the thighs is caused by a disturbance in blood flow to the skin which reduces blood flow and oxygen to the skin. The reduced oxygen causes the blood to look more purple. There are many causes of livedo reticularis but it has been reported to occur for only a short period of time in those with COVID-19. In one case, it lasted less than a day! It often affects just one limb. In those with skin of colour, the areas may just look hyperpigmented (brown-dark brown areas)

4. Other ‘viral’ rashes
There are many other rashes that occur with viral infections that are being reported in people with COVID-19. Conditions like chicken-pox, dengue fever, glandular fever and even inflammation of the blood vessels (called vasculitis) can all causes rashes and these kinds of rashes have been reported in those with COVID-19.

It is clear from the emerging scientific evidence that skin rashes can be the clue to underlying COVID-19 infection. At this stage we think some rashes are a sign of early, mild infection (like COVID-toes) and others, a more severe infection. We will be keeping up to date with further research on new and useful information about skin signs of COVID-19 and we will keep you updated too. To prevent the spread of COVID-19, remember good hand hygiene and skin care, practice social distancing and see your General Practitioner even if symptoms are mild.

And of course, don’t let COVID-19 get under your skin.  Skin rashes may be a sign of COVID-19 so don’t put off seeing your dermatologist for your skin concerns. Chroma Dermatology offer online consultations so you can access care from the comfort of your own home.

In the meantime, we hope you and your loved ones stay safe.

The information contained in this blog post is intended as a guide only and should not substitute seeking medical attention. Please see your healthcare provider for more information on suitability of products, treatments or procedures.