5 Skin Conditions Dermatologists Say Are Linked To COVID-19

The World Health Organization has listed three of the most common symptoms of COVID-19 as fever, a dry cough and tiredness. Other symptoms include a sore throat, aches and pains, diarrhoea, headache and shortness of breath. But as further details emerge about how COVID-19 affects your body, doctors have discovered more surprising signs of the virus.

Last month, experts in the US reported some skin symptoms including blue and purple discolouration in toes, and sensitive blisters. Now, a new study has found further evidence that a range of skin conditions could be telltale signs of the virus.

Researchers at the Spanish Academy of Dermatology have identified five skincare conditions that are linked to coronavirus, after investigating how the virus might show up in skin symptoms. They studied 375 patients with unexplained skin "eruptions" who had suspected or confirmed COVID-19. These "eruptions" included chilblain-like symptoms, blisters, rashes, bumps and blotchy skin.

While these are common symptoms, experts say that in some cases it was hard to tell if they were directly caused by the virus. The authors of the study, published in the British Journal of Dermatology, have urged the public not to try and self-diagnose COVID-19.

Dr Adil Sheraz, consultant dermatologist and British Skin Foundation spokesperson, agrees: "A variety of skin manifestations have been seen in COVID-19 positive patients. However, we are uncertain whether these are directly related to the virus itself or the complications of the infection."

Experts found that 19% of cases had chilblain-like symptoms. They were described as "acral areas" such as fingers or toes displaying "erythema-edema" (redness and swelling) with some vesicles (small fluid-filled sacs) or pustules. The study describes how these show up as purple or red spots commonly found on hands and feet, caused by bleeding under the skin. It is more common among younger patients, has been found to be a symptom of milder cases and lasts on average for 13 days.

The study also found "vesicular eruptions" in 9% of cases, which have been described as "small blisters, such as those seen in chicken pox or in a herpes (cold sore) infection" by Dr Sheraz. These were more common in middle-aged patients and lasted around 10 days on average in moderate cases.

Researchers identified 19% of cases which brought up "urticarial lesions" which could be interpreted as nettle rash or weals. Dr Sheraz says these present as "raised, red, swollen-looking plaques on the skin which can be itchy". Other names used are hives or welts. 

"Other maculopapules" were identified as small, flat and raised red bumps and were found to be the most common symptom in 47% of cases. These were found around the hair follicle in more severe cases. Dermatologists said this condition was similar to pityriasis rosea, a common skin condition characterised by a scaly rash, and said blood spots might also show up on the skin. "This type of rash is often seen in drug reactions (such as penicillin allergy) or infections like measles," adds Dr Sheraz.

The study pointed to a fifth condition, livedo or necrosis (the premature death of skin), which occurred in 6% of cases. "The skin can sometimes appear blue in areas and paler in others. It’s often seen in conditions such as systemic lupus," says Dr Sheraz. "This can result in painful, swollen and then eventually numb skin." The study found that this condition was more common in older patients with severe cases of COVID-19.

Dr Sheraz encourages those who have spotted a new rash or condition to speak to a doctor. "If you develop a new rash then please speak to your GP or dermatologist. Almost all dermatologists are offering virtual consultations and even face to face in urgent cases. A diagnosis of COVID-19 should not be made from just the presence of a rash."