COVID-19 and Your Skin: Rashes in Coronavirus Infections

Rashes in COVID-19, Ashley Aesthetics

When it comes to COVID-19, there is no doubt that it has touched almost every aspect of our lives. There’s been a lot of talk about the effect mask-wearing is having on our complexions (the dreaded “maskne”), but the viral infection itself can directly cause changes to our skin.

Why are these important to be aware of? We know about the common presenting complaints of COVID, which are generally non-specific (cough, high fever). However, recent research has estimated that about 8% of patients have skin symptoms, and for approximately 1/5 of these patients skin symptoms are the presenting complaint, or only sign of infection they ever have.

What should I look out for?

COVID can manifest in multiple ways on your skin, however there are four key presentations that have been identified. The British Association of Dermatology have put together a brilliant resource of images for COVID skin signs, which you can access here.

Red plaques on your fingers or toes

COVID-19 rashes can present as a red (erythematous) plaque on your fingers or toes, looking similar in appearance to chilblains. This is the specific of all the skin changes seen with COVID, as there are very few rashes that also present in this way. These plaques can form pustules and occur in younger patients. They are usually asymmetrical, meaning they will be in a different pattern on your left versus right extremities. They can appear in the weeks after you have had a COVID infection, disappear, and then reappear again.

Large red, itchy hives on your chest, back, or face

Others develops a red, itchy rash that appears like wheals or hives, usually over the trunk or face. The medical term of this is urticaria. These are usually seen early on during a COVID infection.

Small, red papules over your body

Some patients may develop small red bumps (papules) anywhere on their body, but rarely on their face or neck. These tend to be extremely itchy, and may need to be managed with a steroid cream under the direction of your doctor.

Net-like, red-blue rash on your legs

Older patients have reported a net-like (reticular) red-blue discolouration of the skin of the limbs. This is usually seen with more severe infections, and in patients who have had to go to the hospital. It is seen with more serious disease, so is good to be aware of.

What can I do about it?

As always, if there are any concerns about a COVID-19 infection, contact 111 or your GP for help. If you are very unwell and having any difficulty with breathing, go to your local A&E for assessment.

As far as the skin goes, however, the good news is that most skin rashes will self-resolve and settle with time. Your doctor can help recommend emollient creams to help ease any discomfort, and for some of the itchier rashes a steroid cream or oral antihistamine can be beneficial.

COVID rashes

The key thing to remember is that most rashes associated with COVID-19 infection will go away by themselves, but may relapse or linger for weeks after the acute infection has resolved. You can always ask your doctor for advice if there are any symptoms causing you discomfort.

References

Marzano AV, Cassano N, Genovese G et al. Cutaneous manifestations in patients with COVID-19: a preliminary review of an emerging issue. Br J Dermatol 2020;183(3):431-442.

British Association of Dermatologists. COVID-19 Skin Patterns (collected by COVID Symptom Study App 2020).

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