COVID-19 RASHES

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A tiny virus with a mighty agenda has disrupted our world and our lives, and thrown us in the middle of a war we know very little about. Purpose of this page is to rapidly communicate information on skin manifestations of COVID-19 as it becomes available. Please note that this is a very rapidly evolving illness and we will encounter the many faces and manifestations of this illness. As clinical efforts continue globally, novel findings are being reported across nations and borders.  I will try to update this page as information about it becomes available. The cases reported on this page should be viewed as observations only, and not as recommendations for evaluation or treatment. 

Please refer to World Health Organization (WHO), CDC and your local health agencies for most up to date information about current situation and guidelines, and seek your doctor for any changes in your health or symptoms.

What is COVID-19?

Coronavirus are a large family of viruses that are known to cause common colds, gastro-intestinal diseases, to severe illnesses like MERS (Middle East Respiratory Syndrome) and SARS (Severe Acute Respiratory Syndrome). COVID-19 is the viral respiratory illness caused by a coronavirus that was first identified in Wuhan, China in December 2019, and was named Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2).

How does one catch the virus that causes COVID-19?

The virus spreads mainly from person-to-person and people of all ages can get infected. When an infected person sneezes or coughs, respiratory droplets get deposited on uninfected person, surfaces and, can even get suspended in air.  These droplets can land in the mouths or noses of nearby people (within 6 feet) or when a person touches a surface or object that has the virus on it. When the virus particles are inhaled into lungs, or brought to own mouth, nose or eyes by touching, the infection can start brewing in the next person. Some infected folks spread the virus without even showing signs or symptoms of shedding (asymptomatic shedding).

What are the common signs and symptoms of COVID-19?

Most patients with confirmed COVID-19 suffer from mild to severe respiratory illness with fever, dry cough, shortness of breath and fatigue. Some patients experience muscle aches, headaches, sore throats, diarrhea, or loss of taste or smell. Symptoms usually appear 2-14 days after exposure. 

What is the treatment?

Many patients do not exhibit any symptoms at all and do not even know that they are infected. Most healthy individuals have mild or moderate illness, and do not require a clinic visit or hospitalization. They should self-quarantine at home for 14 days to prevent spread of virus to others. It is still important to monitor your symptoms at home as infected patients can suddenly become seriously ill, especially during the second week of illness. It is recommended to monitor body temperature and oxygen saturation at home using finger tip pulse oximeter.

Who is at risk for acquiring COVID-19?

Those at highest risk for severe illness include elderly, those with certain underlying health conditions or on medications that weaken their immune system. High risk conditions include blood disorders, chronic kidney disease, chronic liver disease, compromised immune system, late term or recent pregnancy, endocrine disorders, metabolic disorders, heart disease, lung disease, neurological conditions. Your doctor can tell you if you are considered high risk patient.

What are the skin rashes seen with COVID-19?

Like most viruses, coronaviruses including SARS-CoV-2, that is responsible for COVID-19, also cause viral exanthem, or skin rashes associated with viral infections. 

 

1) COVID-19 cases in Italy

One study by dermatologists at Alessandro Manzoni Hospital in Lecco, in northern Italy observed skin rashes in about one-fifth (20%) of their COVID-19 patients (J Eur Acad Dermatol Venereol. 2020 Mar 26. https://doi.org/10.1111/jdv.16387)This study reported chicken-pox like rash, diffuse red rash and hives-like rash in patients with confirmed COVID-19. 

Skin rashes we are seeing in COVID-19 patients“ are similar to cutaneous involvement occurring during common viral infections,” said Dr Sebastiano Recalcati, a dermatologist at Alessandro Manzoni Hospital.

2) COVID-19 cases in Thailand

We are also seeing case reports emerging from Thailand where first case of COVID-19 was diagnosed in January 2020. A COVID-19 patient presented at a Bangkok hospital with rash that looked like the rash of dengue fever, with low platelet count and petechiae (red pin point rash from bleeding under the skin). It was initially misdiagnosed with Dengue because of clinical similarity. Patient was eventually diagnosed at a tertiary center where he presented with respiratory issues (J Am Acad Dermatol. 2020 Mar 22. pii: S0190-9622[20]30454-0. doi: 10.1016/j.jaad.2020.03.036)

3) COVID-19 cases in US

Dermatologists across the nation are exchanging observations from their outpatient dermatology offices of COVID-19 confirmed or suspected rashes. There have been many reports of COVID-19 associated livedoid rash and perniosis (chilblains) rash. Similar reports are coming out of France.

Click on representative photos to read more about the clinical presentation, signs and symptoms of these skin conditions.

Dengue Rash
http://toquesonmoto.blogspot.com/2010/05/dance-with-dengue.html
Dengue Rash:
red diffuse rash of Dengue
Dengue Rash
Diffuse red rash of Dengue with islands of sparing
Dengue Rash
Diffuse red rash of Dengue
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Urticarial (hives)
Wheals of hives
Urticaria (hives)
Raised plaques of urticaria
Urticaria (hives)
Blotchy raised plaques of hives
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Chicken pox like rash
Water blisters with bloody crust
Chicken pox like rash
water blisters in red base
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Petechial rash
Bright red rash from bleeding under the skin
Petechial rash
Bright red rash from bleeding under the skin
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Chilblains/Perniosis
Tender, itchy areas on toes
Chilblains/Perniosis
Red or violaceous discoloration of toes
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Livedo Reticularis
Mottled lacy skin
Livedo Reticularis
Mottled lacy appearance of skin
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