COVID-19 and Skin Rashes

Coronavirus disease-19 (COVID-19) is an ongoing global pandemic caused by the “severe acute respiratory syndrome coronavirus 2” (SARS-CoV-2), which was isolated for the first time in Wuhan (China) in December 2019.

Although COVID-19 is best known for causing fever and respiratory symptoms, it has been reported to be associated also with different extrapulmonary manifestations, including dermatological signs.

Is a Skin Rash a Symptom of COVID-19?

Some inpiduals with COVID-19 may develop a rash. Rashes are typically discolored in comparison to neighboring skin. On light skin, a rash may look red, pink, or purple. On dark skin, it may appear purple, ashy grey, or dark brown. The affected area may appear swollen or puffy compared to surrounding skin. Many, but not all, types of COVID-19 rash may itch.

COVID-19 rash can last 2 to 12 days. On average, most people have a rash for 8 days. However, rashes impacting the toes may last 10 to 14 days.

Skin manifestations associated with COVID-19 are extremely polymorphic. The exact appearance of COVID-19 rashes can vary by inpidual. While some infectious diseases, such as chickenpox and measles, cause a very distinctive rash, a rash due to COVID-19 can take many forms.

Urticarial Rash

Urticaria and angioedema can be triggered by viral and bacterial agents, such as cytomegalovirus, herpesvirus, and Epstein-Barr virus and mycoplasma. Urticaria-like eruptions have been described in 19% of COVID-19 cases , simultaneously with systemic symptoms. They lasted approximately for 1 week and were associated with medium-high severity of COVID-19. Moreover, itch was almost always present. Urticarial lesions predominantly involved the trunk and limbs, relatively sparing the acral sites.

Urticarial lesions associated with fever were reported to be early or even prodromal signs of COVID-19, in the absence of respiratory symptoms, in some patients.

COVID-19-related urticaria occurred also in a familial cluster. Angioedema may accompany COVID-19-related urticaria.

Macules and Papules

A maculopapular rash is made of both flat and raised skin lesions. The name is a blend of the words “macule,” which are flat discolored skin lesions, and “papule,” which are small raised bumps. These skin lesions are usually red and can merge together. Macules that are bigger than 1 centimeter are considered patches, while papules that are merged together are considered plaques.

A maculopapular rash is a marker for many diseases, allergic reactions, and infections. Most of the time, the cause is a viral infection.

In some cases, a COVID-19 maculopapular rash can consist of itchy spots that may either be flat or raised. This type of rash often impacts the torso.

Rash with Blisters

This type of COVID-19 rash can appear with blisters that may look similar to chickenpox or erythemato-papular or erythemato-vesicular rash. It may itch. Areas of small, itchy red bumps that can occur anywhere on the body, but particularly the elbows and knees as well as the back of the hands and feet. The rash can persist for days or weeks.

Lace-like Pattern

Some COVID-19 rashes can have rings of skin discoloration that form a lace or net-like pattern. This kind of COVID-19 rash typically affects the legs. It is a sign of poor blood circulation. It was found in older patients with more severe illness. Six percent of the COVID-19 patients had this skin condition.

Pinpoint Spots

This type of COVID-19 rash consists of dark pinpoint spots. The legs are the most commonly impacted area.

COVID Toes

COVID toes, this type of rash causes discolored patches and swelling of one or more toes. The affected area may be painful, itchy, or have a burning sensation. Toe rashes appear to be more common in young adults.

The toe condition might stem from an immune system mounting “a strong antiviral” response to the coronavirus.The skin on one or more of the toes or fingers may swell up and look bright red, then gradually turn purple. Skin of color can look swollen and purple, and brownish-purple spots may appear.

Lots of people don’t feel anything, and they only notice these changes when looking at their toes or fingers. But along with swollen, discolored skin, it’s also possible to have blisters, itching, pain, raised, painful bumps and areas of rough skin. Some people also notice a bit of pus under their skin. The condition can show up at any age, but you may be more likely to get it if you’re a child, teen, or a young adult.

What Causes COVID-19 Rash?

Researchers don’t understand why some people with COVID-19 get a rash and others do not. They also don’t know what exactly causes the rash to occur. Some possible mechanisms include direct infection of skin tissues by the novel coronavirus, immune system activity and the effects of increased blood clotting (hypercoagulability) that can sometimes happen in COVID-19.It’s also possible that different types of COVID-19 rash will happen through different mechanisms.

Multisystem Inflammatory Syndrome in Children (MIS-C)

MIS-C is a potentially serious complication of COVID-19 in children and causes various organs in the body to become inflamed.

Skin symptoms are associated with MIS-C and can include rash, redness of the hands, feet, or both and lips that are dry, red, or cracked. Other potential symptoms can include red, bloodshot eyes, fever, extreme fatigue, abdominal pain, digestive symptoms like vomiting and diarrhea and neck pain.

Allergic Reaction

Some people may have an allergic reaction to the COVID-19 vaccine. If this happens, you may notice a rash or hives after you get your vaccine.

Allergic reactions to the COVID-19 vaccine can be classified as either non-severe or severe. Non-severe allergic reactions happen within 4 hours of vaccination. They may include signs such as hives, swelling, and wheezing. Severe allergic reaction, is called anaphylaxis. It typically happens in the minutes after vaccination and can include hives, swelling of the face and throat, and dizziness or fainting.

Delayed allergic reactions may occur in some people ( COVID arm).This type of rash is most often associated with the Moderna COVID-19 vaccine and typically happens after the first dose. However, it can also occur after the second dose or after both doses.

Delayed rashes at the injection site typically appear about a week after vaccination and last about 4 days . This rash can be large and include symptoms like redness, swelling, warmth, itching and pain. This type of reaction isn’t harmful. If you have a delayed rash at the injection site, you still can receive the second vaccine dose, if applicable. However, you may receive it in your other arm.