The three most common symptoms of coronavirus are well documented, a fever, a dry cough, and losing your sense of taste and smell are three tell-tale signs of the virus we have all been warned over since the beginning of the pandemic.
Outside of the “classic three”, there have been a number of lesser but still common side-effects reported by people who have tested positive for the disease, such as headaches, muscle and joint pain, nasal congestion, and fatigue.
However, one symptom of coronavirus that has not attracted as much attention is the variety of rashes it can cause to appear all over the body.
Though the rashes are less common than other symptoms, it is vital you know how COVID-19 can impact the skin so you can identify a potential infection as early as possible. A recent study found that for 17% of COVID-19 patients with more than one symptom, skin rashes were the first symptom to appear, while for 21% of patients rashes were their only symptom.
The four main types of skin rashes to occur when infected with coronavirus are listed below, with the potential reasons as to why they have occurred.
Chilblain-like lesions
These types of skin deformities affect mainly the toes and soles of the feet, which is why you may have heard of them under a more simple name of “COVID toes”.
After one to two weeks of first appearing, the lesions will become even more discoloured but reduce in swelling, before eventually resolving without treatment.
These kind of red, swollen blisters have been more commonly spotted among adolescents and young adults with no or only mild symptoms of COVID-19. They are the most common skin issue that is related to the virus.
It is vital to note that no actual, concrete medical evidence can link the skin lesions to directly being infected with COVID-19, chilblain-like lesions can appear as a result of a number of other illnesses and though the large rise in the number of these lesions during the pandemic suggests they’re associated with COVID-19, direct confirmation of this is yet to be established.
A study that analysed 26 patients with suspected COVID-related skin changes discovered that 73% of those participating presented chilblain-like lesions. Surprisingly, none of the patients had respiratory symptoms and all tested COVID-negative at the beginning of when their lesions appeared.
One theory suggests that the lesions are triggered by damaged blood cells caused by the body’s immune system’s response to the virus infection or multiple mini blood clots in the toes.
Maculopapular rash
This kind of rash triggers both flat and raised areas of discoloured skin. A Spanish study of 375 patients with COVID-related skin changes found that 47% displayed this kind of rash.
This rash is associated with more severe COVID-19 symptoms, found mostly in middle-aged to elderly patients. They often lasted 7-18 days, appearing 20-36 days after infection.
Much like with chilblain-like lesions, maculopapular rashes could be triggered by the body’s immune system fighting hard against the infection. In some instances, a hyperinflammatory phase begins 7-10 days after infection, which in turn leads to tissue damage and in a worst case scenario more severe disease and death.
Hives
Hives are raised areas of skin which often itch and irritate. When related to COVID-19, Hives typically precede or present at the same time as other symptoms, making them easier to identify as a symptom of coronavirus.
They are most common among middle-aged patients and are associated with more severe disease. Hives appear following infections as they cause the breakdown of cells which then sparks the release of histamine via the immune system.
Drugs that are used to treat COVID-19 can also cause Hives, such as corticosteroids and remdesevir.
Vesicular lesions
Visually similar to chicken pox, vesicular lesions are clear fluid-filled sacs that form under the skin. In relation to coronavirus, vesicular lesions are the most uncommon skin rash of those listed – with the previously mentioned Spanish study showing that only 9% of COVID-infected patients displayed these lesions.
They often appear in patients with mild disease around 14 days after initial infection. They are triggered by a lengthy period of inflammation, with antibodies attacking the skin and damaging its layers, resulting in fluid-filled sacs.