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Numerous reports of skin rashes in COVID-19 patients are emerging worldwide.
Rashes can take many forms: some appear as small red spots, while others appear as larger flat or raised lesions. Some have a beehive appearance, while others look like frozen fingers.
However, it is too early to say whether these eruptions are actually caused by the new coronavirus or related to other factors. “That’s really the million dollar question,” said Dr. Kanade Shinkai, a professor of dermatology at the University of California, San Francisco, and editor-in-chief of the journal JAMA Dermatology.
“It is not clear if the skin lesions we see at COVID are actually a direct manifestation of the virus” on the skin, or if they are a “reaction pattern” due to a general increase immune systemShinkai told Live Science.
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It is also possible that some rashes are due to complications of the disease, reactions to medications, or even other viruses in patients with “co-infections,” Shinkai and colleagues wrote in an editorial published April 30 in the journal. JAMA Dermatology.
Social media posts and online forum discussions have drawn attention to these eruptions, but “now is the time for rigorous science,” the authors wrote. Work is needed to address many unanswered questions, such as how common are rashes and what do they mean regarding the patient’s bottom line.
How common are these rashes?
It is well known that some viral diseases, such as chickenpox, measles and hand, foot and mouth disease, can cause rashes. But virus-related rashes are more common in children, Shinkai said. “So it is much more surprising” to see numerous reports of rashes in adult patients with COVID-19, he said.
Exactly how common the rashes are is unclear. In an early study of more than 1,000 COVID-19 patients in China, published Feb. 28 in the New England Journal of Medicine, rashes were observed in only 0.2% of patients. However, in a more recent study of around 150 patients hospitalized with COVID-19 in Italy, rashes were found in 20% of patients. The latest study, published March 26 in the Journal of the European Academy of Dermatology and VenereologyIt was performed by dermatologists, who “will be able to detect more subtle changes in the skin” than doctors from other specialties, Shinkai said.
More studies that follow patients over a period of time are needed to get a better idea of the true prevalence of COVID-19-related rashes, Shinkai said. Still, a challenge to this is that some patients may have mild symptoms or no other symptoms of the disease, and you may never be diagnosed with COVID-19, he said.
How are the rashes?
Different skin rashes can sometimes be a “telltale sign” of a particular infection. It remains to be seen if this will be the case for COVID-19 patients, according to the JAMA editorial.
So far, a variety of rashes have been observed in patients with COVID-19. A Spanish study published on April 29 in the British Journal of Dermatology They grouped coronavirus-related rashes into five categories: a “maculopapular” rash or a feature of viral infections such as measles, with red bumps on the reddish skin; a “hives” rash characteristic of hives; a ‘Livedo” rash with a lace or fishnet pattern; a “vesicular rash” or blistering rash; and a freeze-like rash on the toes, unofficially called “greedy toes. “
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Also, a recent case report published on April 30 in JAMA Dermatology described the case of a man in Spain who developed “petechiae”, or small red spots on the skin; and a separate case report, also published in JAMA Dermatology, described a patient in France who developed larger lesions known as “fingered papulosquamous rash.”
The timing of rash symptoms with COVID-19 also appears to vary widely: in some cases, rashes precede symptoms such as fever; in other cases, the rashes may appear a few days after illness or may not appear late in the course of infection.
Questions without answer
Research is needed to comprehensively assess these eruptions and when they occur, Shinkai said. Doctors will also need to examine tissue samples to determine if the virus that causes COVID-19, known as SARS-CoV-2, can be detected on the skin, as is the case with some viral diseases that cause rashes, Shinkai said.
In addition, the importance of these rashes should also be studied, as if they are linked to better or worse outcomes for patients, he said. For example, some patients with greedy fingers have been reported to have mild or asymptomatic cases of COVID-19, Live Science previously reported.
To help doctors learn more about COVID-19 and skin rashes, a working group from the American Academy of Dermatology has created an online COVID-19 dermatology registry, where healthcare providers can report findings disease-related skin conditions, Live Science previously reported.
Originally published in Living science.
