COVID-19 is a virus that can affect all systems, and while most think first of it threatening our breathing, it can put a considerable burden on our skin too. As doctors, we’ve certainly seen increased numbers of skin rashes and associated skin problems, and there’s anecdotal evidence that it can impair wound healing. For 1 in 5 people with COVID-19, a skin sign may be the only symptom they get.
COVID-19 skin signs fall into two categories – common conditions that have increased in number (such as urticarial), and rare conditions that have also increased, such as those affecting the toes or mouth.
The COVID ZOE symptom app has looked at data from millions of people with COVID-19 symptoms. The doctors behind it, from Kings College London, have argued that skin signs are now so common with COVID-19 that it should be listed as a key sign of COVID-19 infection, alongside fever, cough and loss of sense of smell.
It isn’t clear if the virus causes these changes directly or via the immune response it provokes, but nearly half appear at the time of infection, with about a third appearing following infection. It’s also worth noting that it’s common to get a rash after any mild viral illness, such as a cold.
COVID-19 can cause any skin rash, particularly those that are itchy. Prickly heat or a chickenpox-type rash seems to be the most common type, causing small itchy red bumps or blisters, which may become weepy or crusty. This often starts on the knees, elbows, the backs of hands and the feet, then spreads across the body, but spares the face. This often appears much later than other COVID-19 symptoms - even weeks or months later - and lasts for weeks.
Urticaria, otherwise known as hives or stinging nettle-rash, is the second most common rash and this appears as itchy red blotches that come and go within hours. New ones can form anywhere on the body and face, and you may get swelling in the lips or around your eyes. It’s often an early sign of COVID-19 infection.
Chilblains are found in Arctic explorers and people exposed to the cold for long periods. They occur when blood vessels become inflamed in response to repeated long periods of cold conditions, or if you have a problem with your blood supply. They can cause a great deal of pain, and sometimes itching. However, the COVID pandemic has brought them to the fore, where they’ve become known as ‘COVID toes’ or COVID fingers and can occur even in warm conditions. The spots this causes on light skin may appear red or purple, and on skin of colour they may look dark brown or black. These areas are usually very painful, especially when using them, such as walking or typing.
These spots can appear weeks or months after the initial COVID infection, and are more common in mild infection and those who are younger. They can last up to 3 months, and the skin then often peels as they clear up.
COVID tongue is the description for a patchy red tongue triggered by COVID infection and is similar to a harmless condition called geographical tongue, where the surface of the tongue resembles a map. People have also reported a dry mouth, thrush or other fungal infections in the mouth. Mouth ulcers or sores may occur, and take a couple of weeks to clear up.
Urticaria is usually histamine-driven, so an anti-histamine tablet can help to clear the rash and relieve the itching. A non-sedating type is best in the daytime (such as loratadine or cetirizine) and a sedating antihistamine (such as chlorphenamine) is sometimes helpful for itching at night.
Cooling agents such as aloe vera gel or Dermacool can also help ease itchy skin, especially if you keep these in the fridge, and tepid showers or baths or a cool flannel may also help. Keep any weeping or crusty rashes clean once a day and pat the skin dry after bathing or shpwering rather than rubbing it with a towel.
Painkillers such as paracetamol can help with COVID toes or any other pain, and it’s fine to take ibuprofen with COVID-19 infection too.
Bonjela or antiseptic mouthwashes can be useful to help relieve oral ulcers and clear them up.
If the rash or other COVID symptoms are not bothersome, keep yourself well with plenty of hydration, healthy well-balanced meals and lots of rest. This gives your body the space it needs to fight any infection, calm any immune response and recover.
If you have a painful or itchy rash that hasn’t responded to simple home measures, it’s worth seeing your doctor to discuss the next steps. Your doctor may be able to advise you as to what the rash is and what may help. With urticaria, if over-the-counter anti-histamines haven’t helped, they can prescribe something stronger to ease symptoms. For COVID toes, you may need stronger painkillers in the early days. Your doctor can also prescribe an anti-fungal tablet or mouth wash to treat any oral thrush.
They may suggest emollients – medical grade moisturisers – to help relieve and repair skin, and a steroid cream may help to ease skin inflammation. Ultimately, most rashes resolve on their own with time, and most COVID-19 infections clear up without long-term complications.
*Correct on 9 February 2023
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