If you’re struggling to keep up with the constantly evolving coronavirus symptoms, you’re not alone. While COVID-19 seems to primarily affect the lungs, doctors are sharing reports of it wreaking havoc on other parts of the body too, including the heart, the senses, the brain, the gut and — based on a growing database of case reports from dermatologists worldwide — the skin.
“We don’t really know what’s happening,” Carrie Kovarik, MD, associate professor of dermatology at the Hospital of the University of Pennsylvania tells Yahoo Life. “We know that most people who are fighting this [virus] are seeing it for the first time, so the immune system is going crazy.”
Kovarik is a part of a nationwide COVID-19 task force created in early April to track and study the many skin reactions that have been linked to the coronavirus. As a part of that effort, experts at Harvard University and the American Academy of Dermatology have joined forces to create a database where clinicians can submit case reports on what they’re seeing. One of the most common thus far is what’s being dubbed “COVID toes” — but that’s not the only one.
“What I would want to emphasize is that there are multiple skin reactions at this point of COVID-19 infection,” Dawn Davis, MD, chair of the clinical dermatology division at the Mayo Clinic tells Yahoo Lifestyle, adding that it’s unclear whether multiple rashes can appear at once. Davis says individuals should be aware of these rashes “even if they have no other symptoms consistent with COVID-19” and should contact their primary care provider to determine whether an evaluation is needed.
Here, Davis unpacks the newest potential signs of the virus and how to spot them early on.
1. A “dengue fever-like rash” that forms large red patches
Davis says that the initial reports involve a rash resembling the one caused by the mosquito-borne illness dengue fever. “It starts out as small, mild to moderately red bumps on the skin and as they increase in density they cluster together into large patches on the skin,” says Davis. “What's interesting about this rash — similar to dengue fever — is that there will be what we call an ‘island of sparing’ where certain patches of the skin won't have any involvement.”
The rash seems to not only be appearing in the U.S. but in other countries as well. In a recent paper from the Journal of the American Academy of Dermatology, doctors in Thailand described a patient who ultimately tested positive for COVID-19 but was initially diagnosed with dengue fever based on a rash that resembled it. Davis says the rash may progress rapidly over a couple of days, and in some cases has appeared before respiratory symptoms.
2. Hives-like rash that either spread or remain the same in size
Davis says that what’s often considered an allergic reaction may actually be showing the presence of the coronavirus. “Some patients with COVID-19 have presented with small to medium hives that spread over their body and then expand in size — although for some patients they stay the same in size,” says Davis. “People think they've gotten into something that they're sensitive to when actually it's their manifestation of the virus.”
This type of rash, she says, is not necessarily a new one when it comes to infections. “[Hives] are not an uncommon reaction to viral infections in general,” says Davis. “It’s a sign on your skin that your immune system is revved up — and that is indeed what's happening in COVID.”
3. Measles-like rash that creates “little dots all over”
Measles recently returned to the U.S. after being eliminated in the year 2000, but Davis says that the rash resembling it could be COVID-19 in some cases. “This rash also comes up in a spotted fashion but doesn't progress any further and simply looks like the patient has measles,” says Davis. “It’s red, small bumps all over but they don't come in at enough density to make large patches ... They just simply look like little dots all over the place.”
4. Discoloration of the skin that forms in a tree pattern
One of the more unusual rashes is one called “livedo” and is defined as “a bluish usually patchy discoloration of the skin.” Davis says this type of rash can appear from emotional responses, such as being afraid or embarrassed, or can be in reaction to the cold. But in this case, it’s an immune response. “Some patients with COVID are getting a livedo pattern on their skin and that's when it looks faint as if you've been embarrassed or cold or scared, but some patients are having a more intense livedo rash, meaning that it's just redder and appears coarser,” says Davis. “Then because it's darker, it can appear similar to vasculitis or your blood vessels get inflamed.”
While it’s unclear exactly what’s happening to cause this rash, Davis says that more severe cases may be a sign that the immune system is in such overdrive that it’s causing the blood to clog. Reports of amputations due to COVID-19, most recently in Broadway star Nick Cordero, bolster this theory.
5. Small, red to purple bumps or nodules on the hands and feet
The final skin reaction, technically known as “pernio,” has earned the name “COVID toes” among those sharing it online. But Davis says the reaction can occur just as frequently in the fingers and hands. “Pernio is the skin condition that happens when people's blood vessels get clotted or inflamed due to cold,” says Davis. As pediatric dermatologists shared in earlier interviews with Yahoo Life, the condition appears to be a growing “epidemic” in kids nationwide.
More research (and access to testing) is needed before doctors can definitively link pernio — and all of the skin reactions above — to COVID-19. But Davis says that, for now, the rashes may serve as an important indicator of infection. “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 Davis. “The best treatment for these skin rashes at this point is to treat the patient's underlying conditions from COVID-19.”
For the latest coronavirus news and updates, follow along at https://news.yahoo.com/coronavirus. According to experts, people over 60 and those who are immunocompromised continue to be the most at risk. If you have questions, please reference the CDC’s and WHO’s resource guides.
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