COVID-19 Rash

Updated in 4/28/2020 to reflect new information emerging from the scientific and medical communities.

Did you know that in one study in Italy, 20% of patients with COVID-19 had a rash? Wow! I hadn’t heard that before, so let’s learn together. The original Italian report results are shown below and suggest that patients had the type of rashes commonly seen with other viral illnesses.

Other skin findings that have been reported include Livedo reticularis and purpura. Livedo reticularis is a net-like pattern on the skin where we are visualizing the blood vessel network in the skin. Purpura is a bruise-like discoloration in the skin that comes from blood leaking into the skin. These two rash patterns are likely due to the inflammatory changes of COVID-19. Although there has been no correlation between disease severity and a particular rash, livedo and purpura are more likely the results of alterations in blood flow, inflammation, and clotting factors. Likely demonstrating what it is going on internally in vital organs. While in residency, I saw quite a few patients in the ICU with both livedo and purpura as their body tried to cope with the failure of internal organs from other diseases.

Another possible sign of COVID-19 is what is being called “COVID toes”. COVID toes are red and purple discoloration on the toes that likely are the result of clotting issues in the skin of the toes. These lesions appear similar to pernio and frostbite. Although seemingly benign and seen in healthy appearing patients, COVID toes likely are a window into the altered clotting mechanisms seen throughout the body. There are now increasing reports of clotting issues in COVID-19 leading to strokes and more. If you think you have “COVID toes” please schedule a televisit and get tested immediately for COVID-19. If additional symptoms of respiratory illness or stroke develop, go to the emergency room.

All of these findings are what we call non-specific, meaning that all of these rashes can occur outside COVID-19. Often patients with viral illness of any kind will develop a diffuse fine red rash that starts on the trunk. Urticaria, or hives, can be seen in a large variety of circumstances.

All of this is still developing, and I’ll try to keep my patients up to date!

Please, if you have a rash that you are trying to figure out, schedule a televisit. Please DO NOT come to the office building if you suspect COVID-19.

If you are worried about the rash you have and COVID-19, think about the following questions, and schedule a televisit if you are still concerned.

How long have you had the rash? If you have had the rash for 4 weeks or more and you are otherwise well, it is unlikely that the rash is related to COVID-19.

Are you ill at all? Fever, headache, sore throat, diarrhea, shortness of breath? Your rash may or may not be related to COVID-19.

Have you been in contact with someone who has COVID-19 and/or you are awaiting testing? If you have a rash, it could be the first sign.

I hope this helps! I learned a lot from writing this. Most of the information now is so new that it is coming from social media and main-stream media sources. It will be months or years before we have real long-term scientific studies.

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