Does COVID-19 Cause a Rash?

The effects of COVID-19 stretch beyond the disease's original respiratory issues, including gastrointestinal, neurological, and even dermatological symptoms. In particular, assorted skin rashes have emerged with the virus in a growing number of patients.

Unlike distinctive rashes typically associated with viral infections such as chickenpox or measles, COVID-19 skin conditions are not uniform, and they seem to come and go, according to the American Academy of Dermatology Association.

"It's not unique that a virus would give you a skin rash," Connecticut-based dermatologist Mona Gohara, MD, told Health.

Are These Rashes Different?

"What we're seeing is transient livedo reticularis, a dermatological diagnosis that's usually autoimmune-related," said Randy Jacobs, MD, a California-based dermatologist who reported a COVID-19-associated rash in an issue of the Journal of the American Academy of Dermatology. "Normal livedo reticularis usually lasts a long time; sometimes it's even permanent. It's not something that comes and goes." This rash doesn't itch, and it presents itself as tiny purple, red, or brown spots that look like bruising under the skin.

Sometimes, the rashes are hive-like itchy rashes, pink-reddish spots, or reddish-purple patches on the toes or fingers, mostly in children and young adults, according to Penn Medicine.

In Italy, a March 2020 observational study reported in the Journal of the European Academy of Dermatology and Venereology showed that 20.4% of the participating 88 patients developed some form of skin condition speculated to be related to COVID-19.

And, a 2020 study in the Journal of the American Academy of Dermatology investigated the similarities between COVID-19 rashes and dengue fever. "There is a possibility that a COVID-19 patient might initially present with a skin rash that can be misdiagnosed as another common disease," reported Beuy Joob, PhD, of the Sanitation 1 Medical Academic Center in Bangkok, who co-authored the study.

Also, rashes have emerged in the mouths of hospital patients with COVID-19 and skin rashes. A 2020 study in JAMA Dermatology observed that six of 21 people (or 29%) had an "enanthem" rash, meaning that it was inside the body, specifically in their mouths. Four of the six were women. The rashes appeared, on average, about 12 days from the onset of their COVID-19 symptoms. Five of the patients developed a type of rash that looked like tiny spots, called petechiae.

The presence of a mouth rash, and petechiae, in particular, suggested that a viral infection, as opposed to an adverse drug reaction, may have been to blame. Of course, one small observational study does not prove cause and effect. Much more research is needed. But it's another potential clue, one that may have been overlooked because of safety concerns. "Many patients with suspected or confirmed COVID-19 do not have their oral cavity examined," the authors pointed out.

Why Might Rashes Be Appearing With COVID-19?

Usually, skin irritation or exposure to an allergen can cause a rash that itches, which would be pretty common if you are frequently washing your hands.

In this unique case, this itch-free rash could be caused by your immune system's response to the virus. "If (the rash) is transient (coming and going), what we suspect is that a bunch of viral particles is being released into the bloodstream at that particular moment," Dr. Jacobs told Health. "The rash itself is caused by a blockage of blood called vaso-occlusion. When you block the blood, you don't get oxygen."

Rachel Nazarian, MD, a New York-based dermatologist and a fellow of the American Academy of Dermatology, attributed these rash patterns to poor circulation in relation to COVID-19, given that many patients deal with heart issues associated with the disease. "What we're finding could essentially be little baby strokes due to decreased blood circulation, related to COVID-19's ability to possibly increase the blood to clot."

The prevalence of dermatological symptoms has increased as the virus has progressed. "While the frequency remains unknown, reports have ranged from 0.2% early in the pandemic, to as high as 20.4%," according to the Centers for Disease Control and Prevention (CDC). The American Academy of Dermatology keeps a photographic file of various rashes that may be related to COVID-19.

If you develop a rash, talk with your dermatologist to determine a potential course of treatment, one that may lead to COVID-19 testing.

The information in this story is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. While Health is trying to keep our stories as up-to-date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using the CDC, WHO, and their local public health department as resources.