It seems like every day we turn on the news and learn something new about the coronavirus, Covid-19, that has completely turned life as we know it upside down. The “invisible enemy,” as government officials call it, manifests differently in each person—many individuals are even asymptomatic, which makes the spread of the virus very difficult to contain. In addition to a fever, sore throat and cough (among other symptoms), mysterious skin rashes are now being identified on certain infected patients. Here’s what the experts know right now.
The Latest Findings
New York dermatologist Doris Day, MD is seeing a broad array of findings. “Some manifestations are stress reactions like flares of acne, hives and stress shedding of hair. Some are rashes that look like chicken pox, or viral rashes like the ones dubbed ‘Covid Toes,’ where there are violaceous skin changes of the toes—sometimes we’re seeing it on the fingertips, too,” she says. “We are actively collecting data on the numbers of patients who test positive for Covid and have had these skin conditions. In Italy, they noted that about 20 percent of patients also had some form of skin finding along with the infection.”
According to New York dermatologist Dhaval Bhanusali, MD, dermatologists do not yet know why the “Covid toes” phenomenon is happening, but “there is a hypothesis that the virus can cause a ‘pro-clotting’ state, and with little emboli potentially leading to small occlusions in the vessels at the distal areas of the body.” Reasons for the other skin conditions like rashes and hives are numerous, as Dr. Bhanusali notes it’s not uncommon for a virus to cause a rash—”it’s a phenomenon known as a viral exanthem,” he says. Dr. Day agrees, saying there are many possible reasons, including an immune response, as with the hives. “Or it could be an effect on the blood vessels and blood itself, causing what’s called coagulopathy, where blood may become sluggish and clot more easily, leading to changes that are first seen at the extremities,” she explains. “We have noticed the changes in the extremities seem to also occur in children who are otherwise healthy and often don’t have other major signs of infection.”
Who They Affect
What’s also interesting, as both Dr. Bhanusali and Dr. Day note, is that “Covid toes” (and some types of rashes) seem to occur more in younger people and children, and many of them have little to none of the general symptoms. “It may represent resolution of the virus, but this is based more on observation,” Dr. Bhanusali says, adding that many of the patients are also testing negative for “active” virus when derms see the rash. However, Dr. Day says that hives, along with a type of rash called livedo (a mottling of the skin), is being linked more to adults.
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When to See a Doctor
“If you think you’re experiencing any of these symptoms, it’s important to see a properly trained, board-certified dermatologist to accurately diagnosis the condition,” Dr. Day stresses, adding that many doctors are offering telemedicine consultations. If you are diagnosed, the treatment protocol is in flux, but seems relatively mild. “Right now, we are either doing topical steroids or just monitoring,” says Dr. Bhanusali. “In some cases, dermatologists have recommended aspirin (low dose), but there are no established protocols and we are continuing to observe in real-time.” According to the experts, the good news is that these skin symptoms resolve within a few weeks, even without treatment, and usually don’t leave any marks or lingering damage to the skin or extremities. To track these dermatologic conditions, the American Academy of Dermatology has established a registry for physicians, so hopefully we will have more detailed information at some point in the near future.
What the Skin Conditions Look Like
Below are images of the many skin manifestations going viral on social media. And as Grapevine, TX dermatologist Sanober Amin, MD points out in her caption: These images are “not intended to replace a professional evaluation by your doctor.” And because information on Covid-19 is rapidly evolving each day, we recommend referring to the WHO and CDC for the latest updates.
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