Skins symptoms observed in COVID-19 patients

A new symptom is popping up in COVID-19 patients. The virus can reportedly affect not only the lungs, but other internal organs as well as the senses – and now dermatologists are observing skin reactions in patients with the disease.

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These reactions include “dengue fever-like rash,” a “hives-like rash,” livedo reticularis, a “measles-like rash” and pernio located on the extremities (also known as “COVID toes”), according to an article from Yahoo Life.¹

“COVID toes,” first noted in March by Italian dermatologists, seems to occur more in pediatric and young adult patients and is characterized by blue or purple lesions appearing on the toes, according to an article from USA Today.²

Interestingly, patients with these skin symptoms do not seem to display any other typical symptoms associated with the virus, including shortness of breath, cough and fever, and also tend to test negative early on.

“This is a manifestation that occurs early on in the disease, meaning you have this first, then you progress,” says Ebbing Lautenbach, M.D., chief of infectious disease at the University of Pennsylvania’s School of Medicine. “Sometimes this might be your first clue that they have COVID-19 when they don’t have any other symptoms.”²

Lesions on the toes have been observed to disappear following 7-10 days in some patients, while others go on to exhibit more classic symptoms of the virus.

Dr. Ebbing tells USA Today these “COVID Toes” could be a part of an inflammatory response or blood clotting.

“The short answer is nobody knows,” he says.

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Susan Wilcox, M.D., chief of critical care for the emergency department at Massachusetts General Hospital, says she has seen these skin lesions in patients with severe cases of influenza or pneumonia, so it wasn’t shocking to see these symptoms arise in COVID-19 patients.²

“The most important thing is recognition of these imitation-like rashes so that the patient can get diagnosed not only for their own health but also from a public health measure,” says Dawn Davis, M.D., chair of the clinical dermatology division at the Mayo Clinic. “The best treatment for these skin rashes at this point is to treat the patient's underlying conditions from COVID-19.”¹

References:

1. Haglage A. Coronavirus is causing hives and 4 other skin reactions - here's what dermatologists warn you to look for. Yahoo! https://www.yahoo.com/lifestyle/coronavirus-hives-skin-reactions-dermatologist-152002908.html. Published April 21, 2020. Accessed April 21, 2020.

2. Rodriguez A. What are 'COVID toes'? Doctors discover symptom of coronavirus mostly seen in kids. USA Today. https://www.usatoday.com/story/news/health/2020/04/21/coronavirus-covid-toes-may-symptom-covid-19-young-people/2994930001/. Published April 21, 2020. Accessed April 21, 2020.