Plus, how to tell the difference between a COVID-19 rash and a regular rash.

By Caroline Shannon-Karasik
Updated Apr 23, 2020 @ 10:00 am
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It's been well over a month since the coronavirus was declared a national emergency in the United States, yet, every day seems to bring with it some new information. By now, we're aware that COVID-19 doesn't always present with a fever and cough, but that nausea and other gastrointestinal issues can also be symptoms. The latest? A skin rash.

"It is common to see a skin rash with a virus because the body has an amazing capacity to respond to something that disturbs the norm," says Marie Hayag, M.D., a New York City-based dermatologist. "In fact, in the dermatology world when someone presents with a rash it can be a sign of an underlying health condition. Sometimes certain rashes can be the presenting sign."

Still, there's a lot we still don't know about "coronavirus rashes." Ahead, experts weigh in on the various types you might experience — and when it's time to see a doctor.

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So, What's the Link Between Coronavirus and Rashes?

The link was discovered recently after a report published in the Journal of the European Academy of Dermatology and Venereology revealed 20 percent of 88 confirmed positive patients in Italy were found to have a rash that appeared either at the onset of diagnosis or after hospitalization for COVID-19.

But the rashes people are experiencing can vary, says Marie Hayag, M.D., a New York City-based dermatologist, and include hives (red or pink bumps on the skin that come and go within a 24-hour period) or a chicken pox-like rash that includes bumps and fluid-filled blisters. Common areas for the rash to appear include the torso, arms, and legs.

"So far we’ve seen a wide spectrum of rashes, including continuous red rashes, patchy rashes, net-like rashes, and even rashes that look like bruises, which can be a sign of clotting in blood vessels," says Nate Favini, M.D., the medical lead of Forward, a preventive primary care practice.

Some COVID-19 patients have even experienced purple or blue lesions on their toes, a rash-like skin condition that has been informally dubbed "COVID toes." This rash is painful or tender to the touch, according to Dr. Hayag.

Still, there are many unknowns when it comes to "coronavirus rashes" and more information is needed to understand its role in identifying COVID-19. As of now, skin rashes are not yet listed by the Centers for Disease Control and Prevention (CDC) or the World Health Organization (WHO) as a common symptom.

Still, the fact that it is now a known symptom may help docs to prevent misdiagnosis in the future. In a recent report published in the Journal of American Academy of Dermatology, it was noted that a COVID-19 patient in Thailand was initially misdiagnosed with dengue fever (a mosquito-borne viral disease) after doctors noticed petechiae, or broken blood vessels, which is a rash common in dengue.

Dr. Favini added: "It’s clear that more research will be needed to understand these rashes better."

How Can You Tell If It's a Coronavirus Rash or Something Else?

Dr. Hayag is quick to point out that although skin rashes are a symptom to consider, "just having a rash does not mean you have COVID-19."

In fact, the alternate causes of a skin rash are endless, says Niket Sonpal, M.D. a New York-based internist and gastroenterologist. "You can have a rash because of contact dermatitis, allergies, medication side-effects, and skin conditions like eczema."

Dr. Hayag agreed, adding that she's "been seeing a lot of flare-ups related to these skin conditions lately,” as a result of increased stress. “Also because of excessive hand washing, use of hand sanitizers, and gloves there has been more hand irritant dermatitis," she noted.

When Should I See a Healthcare Professional?

If you are experiencing a skin rash and do not have a pre-existing chronic skin condition, like eczema or rosacea, or you notice a rash and believe you were recently exposed to coronavirus, then you should see a doctor, Dr. Sonpal says.

"Especially if it's one of the types being observed by dermatologists right now, you should contact your doctor for further guidance and maintain social distance in the meantime," she explains.

In order to keep up to date on the types of rashes that may be linked to coronavirus, Dr. Hayag recommends checking out The American Academy of Dermatology has a COVID-19 Dermatology Registry, which is regularly updated as experts continue to gather data on these COVID-19 rashes.

If you are concerned about a new (or existing) rash, one place to start is with a telemedicine appointment with your doctor, Dr. Favini says. Many providers, like Forward, offer virtual appointments where patients can send pictures of their rashes or ask questions about any symptoms they may be experiencing.

Dr. Hayag adds that she too has begun to see patients for virtual appointments, whether it's for a possible coronavirus-related rash or ongoing skin condition: "I never thought I would ever be using telemedicine, however, it is convenient and reassuring for my patients."

The coronavirus pandemic is unfolding in real time, and guidelines change by the minute. We promise to give you the latest information at time of publishing, but please refer to the CDC and WHO for updates.