Skin Manifestations Associated with COVID-19: Findings to Date

Within a few weeks, COVID-19 has transformed our lives in frightening and devastating ways. And yet at the same time, it has been remarkable to observe our scientific and medical communities unite in a global effort to combat the virus. Our understanding of the virus has expanded daily thanks to these collective efforts.

Viruses commonly cause rashes. These are usually non-specific “morbilliform” (scattered pink spots and bumps) rashes that are the result of an immunological response to a viral material in the body. In some cases, viruses cause a specific type of rash (i.e. the shingles rash is specific to herpes zoster virus). While there is likely no one rash that is specific to COVID-19, the skin is affected in some patients. In a study of 88 hospitalized COVID patients in Italy, 20% developed skin findings that included non-specific pink bumps, hives, and chickenpox-like blisters. In New York City, dermatologists are observing similar reactions in patients.

Perhaps the most interesting skin finding to date is the rash noted on the hands and feet of some children and young adults affected by the virus. Known by the media as “COVID toes,” this refers to tender bruises and occasional blisters that appear on the fingers and toes. This is similar to a common condition we see in dermatology during the winter months called chilblains, which is due to vasoconstriction of the blood vessels. Most of the patients who are presenting with “COVID toes” had only mild viral symptoms of the COVID-19 virus, or never even knew they had the virus. Although much more research is needed, some think that this finding represents a late immune response to the virus.