COVID-19 rashes: How your skin can be a sign of the virus

By DR. ALEXIS E. CARRINGTON and DR. STEPHANIE E. FARBER, ABC News

(NEW YORK) — As the pandemic continues, doctors and researchers are learning more about the symptoms of COVID-19. And, as it turns out, some of them — like rashes — may be easy to see.

One of the most widely talked about skin findings related to coronavirus infection is the so-called “COVID toes” syndrome. Dr. Ginette Okoye, chair of the department of dermatology at Howard University, described these as “a reddish-purple discoloration on the toes, accompanied by swelling and pain.” Like many other symptoms of the virus, COVID toes are caused by “inflamed blood vessels.”

Having COVID toes is not necessarily a cause for alarm, in fact, Okoye said it can be “a sign that your body is mounting a good immune response to the SARS-CoV2 virus, since it tends to occur in patients with otherwise mild COVID symptoms.”

Experts are still debating whether this phenomenon is truly linked to COVID-19.

“There is still controversy with some studies finding an association and other studies that have failed to find an association,” said Dr. Raja Sivamani, a board-certified dermatologist and associate professor of clinical dermatology at the University of California, Davis.

“Most recently, a study published in the British Journal of Dermatology found that the SARS-CoV-2 virus was found in the cells of the blood vessel walls on the toes. This finding supports the idea that COVID is responsible for the development of COVID toes,” Sivamani said.

In addition to COVID toes, Okoye said, “many different types of rashes have been seen in patients with the novel coronavirus, including hives and widespread red rashes, some with small blisters.”

These rashes are even more common in patients who are more severely ill, because of “blood vessel blockage in the skin.” These blood vessel blockages are caused by the body’s immune system trying to fight the virus. Like other symptoms of the coronavirus, Okoye said, “Some of the COVID rashes are caused not by the virus itself, but by the body’s immune response to the virus.”

Do the skin symptoms in COVID-19 seem to differ based on skin tones? According to Okoye, “There have not been many reports of COVID toes in patients in Black and Latino patients.”

Even rashes may be less common in darker-skinned people. However, she said this could be because “discerning redness in the skin of people with darker skin tones can be challenging.” For this reason, it can be easy to miss the skin rashes or other skin conditions from COVID in these patients.

“We are still learning about COVID, but there are no clear-cut differences in the rash between different skin tones,” Sivamani said.

Experts say COVID-19 can cause skin rashes in all ages. Multisystem inflammatory syndrome — an illness that seems to follow infection with coronavirus and impacts children — affects multiple organs and the skin.

“Several children have developed a rare condition similar to a known condition called Kawasaki disease,” said Dr. Crutchfield, a Board-certified dermatologist and clinical professor of dermatology at the University of Minnesota Medical School. “Many of these kids tested positive for COVID-19, and doctors are suspecting a strong connection. Symptoms include a red, itchy, bumpy rash all over the body, and a red peeling rash on the trunk area.”

Even though the idea of rashes and purple toes may frighten some, experts, like Okoye, say the best thing you can do is “protect yourself from becoming infected in the first place.”

And COVID toes are not the only skin problem that’s cropping up during the pandemic, although the most common problem — dry skin — has nothing to do with the virus itself. Because all that hand washing and hand sanitizer can irritate your skin, Okoye said that moisturizing is key.

“Use a moisturizing lotion, immediately after, every time one cleans the hands,” Dr. Crutchfield said.

“If your hands do get very irritated, it will be important to seek help from a physician and a dermatologist,” Sivamani added.

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