We are still learning the many ways in which Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) can impact our bodies during an infection. From fever and a cough, to total loss of smell (anosmia), to no symptoms whatsoever, COVID-19 can look very different from person to person.
This is also true when it comes to the skin. We are learning from hospitals around the world just how many different ways this virus can impact our largest organ. Most people have no changes on their skin whatsoever, but there are a growing number of cases where the only sign or symptom of COVID-19 has been cutaneous. It is important to note that for some patients, the rash will appear several days before a person actually starts to feel unwell. In other cases, the eruption appears days after developing a fever, cough, or trouble breathing.
Here is a brief summary of some of the different skin manifestations attributed to this virus so far.
This is a rash that tends to show up just on the toes (and sometimes also on the heels, palms, and/or fingers) as tender red to purple bumps. It appears almost identical to a skin condition that occurs in both adults and children called pernio that happens after repeated cold exposure.
This condition is characterized by tiny pink bumps with clear fluid in the middle (vesicles). It looks very similar to the rash seen with varicella infection (chickenpox). It tends to be widespread over the trunk, arms and legs.
Another described manifestation of COVID-19 has been the appearance of hives on the skin, also known as urticaria. The trademark of hives is that they tend to show up suddenly on the skin, can be very itchy, and tend to move around on the body. They do not stay fixed in one place for more than 24 hours at a time and can show up on any part of the skin. Hives are a very common skin problem in general. Because they can be caused by any number of things including viral infections, medications, and environmental allergies, pinpointing COVID as the ultimate cause of someone’s hives can be very difficult.
This is a non-specific type of skin rash that appears as small pink bumps and dots scattered diffusely all over the body. Similar to hives, a morbiliform eruption can appear as the result of any number of viral infections or as a sign of an allergic reaction to a number of different medications, in particular antibiotics. Determining COVID as the exact cause can also be challenging in these cases due to the many different potential sources of these skin changes.
This virus can also cause skin changes that mimic a variety of other dermatologic conditions not detailed above such as livedo reticularis, pityriasis rosea, and erythema multiforme. This list is continually being updated as we learn more.
If you are concerned about a new rash on your skin, contact your dermatologist. The Boulder Medical Center dermatology team offers telemedicine appointments, which enable our group to review your symptoms from the comfort and safety of home. Please call (303) 440-3013 for an appointment.
Galván Casas C, Català A, Carretero Hernández G, et al. Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases [published online ahead of print, 2020 Apr 29]. Br J Dermatol. 2020;10.1111/bjd.19163. doi:10.1111/bjd.19163
Jenna Peart, MD is certified by the American Academy of Dermatology.
She earned her Bachelor of Arts in International Studies from Boston College, graduating magna cum laude as a member of the Alpha Sigma Nu Honor Society. She pursued her medical studies at the University of Pennsylvania, graduating in the top ten of her class and was a member of the Alpha Omega Alpha Medical Honor Society. She then moved to Denver to complete her internship at Presbyterian St. Luke’s Hospital followed by her residency training in Dermatology at the University of Colorado.
As a dermatologist, Dr. Peart is inspired by the “reward of seeing someone’s skin condition improve dramatically and knowing how much that improvement brings a new sense of self-confidence and improves that person’s daily quality of life.”