- Patients diagnosed with COVID-19 are starting to develop a rash on the skin, which can vary in severity.
- Many viruses that cause upper respiratory tract infections also causes rashes in the skin, dermatologists say.
- Doctors explain when to seek care if you believe your rash is a symptom of coronavirus.
As more people are diagnosed with COVID-19, new and surprising symptoms of the respiratory illness caused by the novel coronavirus keep coming to the surface. First, it was an intense loss of smell and taste. Then, it was GI issues like diarrhea. Now, new evidence suggests that patients infected with coronavirus can experience a skin rash, too.
An early report published by dermatologists who worked with 88 coronavirus patients in Italy found that 20% of those people had some kind of skin-related symptom. Of those, half developed a rash when they first started showing signs of the virus, and the other half developed the rash after they were hospitalized.
The rash showed up in different ways: The most common form was an erythematous rash, which causes patchy, red skin. Some other people developed hives, and one person had blisters that looked like the chicken pox. People were most likely to develop the rash on their trunk, and some people had itching along with it, but it was usually mild in those who experienced it.
Another report published in the Journal of the American Academy of Dermatology found that one patient in Thailand with a confirmed case of COVID-19 developed a skin rash called petechiae, which are tiny, circular patches that aren’t raised. The patient was originally misdiagnosed with dengue fever, which commonly causes petechiae, only to later be diagnosed with COVID-19.
Doctors are spotting this in the field, too. Rajeev Fernando, M.D., an infectious disease expert in Southampton, New York, says he’s seen a rash “a lot” in COVID-19 patients. “It’s often an erythematous rash,” he says. But, like reports have found, he’s seen a variety of rashes. “Sometimes the rash is diffused, or spread out, and other times it’s localized to one area,” Dr. Fernando says.
The American Academy of Dermatology has now set up a COVID-19 dermatology registry for doctors treating coronavirus patients and for patients with confirmed cases to try to track ways the virus impacts the skin.
Why would the novel coronavirus cause a skin rash?
COVID-19 is caused by a new coronavirus, and there’s a lot that experts are still learning about it and how it behaves. The development of a rash is no exception. “We don’t understand exactly why, but many viruses that cause upper respiratory tract infections also causes rashes in the skin known as exanthems,” says Joshua Zeichner, M.D., director of cosmetic and clinical research in dermatology at Mount Sinai Hospital in New York City. (Exanthems are usually a widespread rash, per Dr. Fernando.)
“Perhaps these are the result of our immune system reacting the virus or the virus may have a direct effect on the skin itself,” Dr. Zeichner says.
It’s likely that the virus causes some form of inflammation in the skin that leads to the rash, says Gary Goldenberg, M.D., assistant clinical professor of dermatology at the Icahn School of Medicine at Mount Sinai in New York City. “Usually the rash is non-specific,” he says. “But there are certain features that are seen under the microscope if a biopsy of a rash is taken.”
However, you shouldn’t assume that you have COVID-19 just because you develop a rash.
Rashes are pretty common outside of COVID-19, and they can be caused by a slew of different things, including simple skin irritation, Dr. Fernando points out.
But, he says, if you develop a rash with a fever, it’s definitely worth calling your doctor. “The fever is a big sign of COVID-19,” Dr. Fernando says. And, of course, the same is true if you develop a dry cough, shortness of breath, or other milder symptoms of coronavirus.
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