Five rashes, including COVID toe, are affecting some hospital patients diagnosed with COVID-19, BBC News reports a small study by Spanish doctors at the Fundación Piel Sana Academia Española de Dermatología y Venereología, Madrid, has found. The rashes tended to appear in younger people and lasted several days.
It is not uncommon for a rash to be a symptom of a virus, such as the spots that indicate chicken pox. But the researchers are quoted in the report as saying they were surprised to see so many varieties of rash with COVID-19.
There have been many reports about "COVID toe” – a rash appearing on COVID patients' feet even in the absence of other symptoms – but lead researcher Dr Ignacio Garcia-Doval said the most common form of rash in the study was maculopapules – small, flat and raised red bumps that tend to appear on the torso. It usually appears later on, after the respiratory manifestation of the disease – so it's not good for diagnosing patients," he added.
All the patients in the study were already in hospital and had respiratory symptoms.
The report says all dermatologists in Spain were asked to share details of COVID patients they had seen who had developed rashes in the previous two weeks. There were 375 in total.
The five rashes were:
Asymmetrical, chilblain-like lesions around the hands and feet, which could be itchy or painful. Generally found in younger patients, lasted on average 12 days, appeared later on in the course of the disease, and were associated with mild infections. Accounted for 19% of cases.
Outbreaks of small blisters, often itchy, found on the trunk and limbs. These were found in middle-aged patients, lasted around 10 days, and appeared before other symptoms. (9%)
Pink or white raised areas of skin that looked like nettle rash, and often itchy. Mostly on the body but sometimes on the palms of the hands. (19%)
Maculopapules – small, flat and raised red bumps. These accounted for 47% of cases. They lasted around seven days and appeared at the same time as other symptoms but tended to be seen in patients with more severe infections.
Livedo (also known as necrosis) was present in 6% of cases. The skin looked blotchy red or blue, with a net-like pattern. It's a sign of poor blood circulation. This appeared in older patients with severe illness.
"The relevance of this study is not so much in helping people self-diagnose, but rather to help build our wider understanding of how the infection can affect people," said Dr Ruth Murphy, president of the British Association of Dermatologists.
Dr Michael Head at the University of Southampton said that rashes were a well-known side effect of many viral infections, including pneumonia.
Abstract
Background: Cutaneous manifestations of COVID‐19 disease are poorly characterized.
Objectives: To describe the cutaneous manifestations of COVID‐19 disease and to relate them to other clinical findings
Methods: Nationwide case collection survey of images and clinical data. Using a consensus, we described 5 clinical patterns. We later described the association of these patterns with patient demographics, timing in relation to symptoms of the disease, severity, and prognosis.
Results: Lesions may be classified as acral areas of erythema with vesicles or pustules (Pseudo‐chilblain) (19%), other vesicular eruptions (9%), urticarial lesions (19%), maculopapular eruptions (47%) and livedo or necrosis (6%). Vesicular eruptions appear early in the course of the disease (15% before other symptoms). The pseudo‐chilblain pattern frequently appears late in the evolution of the COVID‐19 disease (59% after other symptoms), while the rest tend to appear with other symptoms of COVID‐19. Severity of COVID‐19 shows a gradient from less severe disease in acral lesions to most severe in the latter groups. Results are similar for confirmed and suspected cases, both in terms of clinical and epidemiological findings. Alternative diagnoses are discussed but seem unlikely for the most specific patterns (pseudo‐chilblain and vesicular).
Conclusions: We provide a description of the cutaneous manifestations associated with COVID‐19 infection. These may help clinicians approach patients with the disease and recognize paucisymptomatic cases.
Authors
C Galván Casas, A Català, G Carretero Hernández, P Rodríguez‐Jiménez, D Fernández Nieto, A Rodríguez‐Villa Lario, I Navarro Fernández, R Ruiz‐Villaverde, D Falkenhain, M Llamas Velasco, J García‐Gavín, O Baniandrés, C González‐Cruz, V Morillas‐Lahuerta, X Cubiró, I Figueras Nart, G Selda‐Enriquez, J Romaní, X Fustà‐Novell, A Melian‐Olivera, M Roncero Riesco, P Burgos‐Blasco, J Sola Ortigosa, M Feito Rodriguez, I García‐Doval
[link url="https://www.bbc.com/news/health-52493574"]Full BBC News report[/link]
[link url="https://onlinelibrary.wiley.com/doi/abs/10.1111/bjd.19163"]British Journal o Dermatology abstract[/link]