COVID-19 can cause various forms of skin discomfort or pain. These manifestations range from visible changes on the skin’s surface to unusual sensations and widespread body aches that can be perceived as skin pain. Understanding these diverse impacts can help individuals recognize potential signs of the illness.
Visible Skin Changes
Individuals with COVID-19 may develop a range of visible skin manifestations. One common type is a maculopapular rash, which presents as multiple small, flat, or raised red, purple, or brown bumps, often appearing on the trunk and potentially itching. Urticaria, also known as hives, characterized by raised, itchy welts that can vary in size and appear red, purple, or skin-colored. These hives can emerge early in the infection.
Vesicular eruptions, resembling tiny fluid-filled blisters, may appear on the trunk and spreading to the limbs, including palms and soles. Additionally, some individuals, particularly children and young adults, may experience “COVID toes,” which involve swollen, red, or purplish discoloration of the toes or fingers, sometimes accompanied by pain, itching, or blisters. Less common but more severe are vaso-occlusive lesions, which manifest as purple or brown patches due to blocked small blood vessels in the skin, often seen in hospitalized patients.
Unusual Skin Sensations
Beyond visible changes, COVID-19 can lead to a variety of unusual sensory experiences in the skin. These sensations are often neurological in origin, indicating potential nerve involvement. People have reported feelings such as burning, tingling, or numbness on their skin, a phenomenon sometimes referred to as paresthesia.
Hypersensitivity to touch, known as cutaneous hyperesthesia or allodynia, occurs where light touch or pressure can cause disproportionate discomfort or pain. These nerve-related sensations can occur in various parts of the body, including the extremities. While these symptoms often resolve, some individuals experience them persistently as part of long COVID. The virus may trigger nerve inflammation or directly damage peripheral nerves.
Widespread Body and Muscle Discomfort
COVID-19 causes generalized body aches, muscle pain (myalgia), and joint pain (arthralgia). These pains can be widespread and sometimes perceived as a deep tenderness or aching in the skin, even though the underlying issue is systemic rather than directly skin-deep. Myalgia is a frequent symptom, and it can be present even before other typical COVID-19 symptoms. Joint pain often affects areas like wrists, ankles, shoulders, and knees.
The widespread nature of this pain stems from the body’s inflammatory response to the infection. While not direct skin lesions, the intensity and diffuse nature of these aches can create a perception of skin hurt or tenderness.
The Science Behind COVID-Related Skin Pain
The mechanisms behind COVID-19’s impact on the skin and associated pain relate to the body’s immune response to the SARS-CoV-2 virus. An overactive immune response can lead to excessive inflammation, sometimes described as a “cytokine storm,” where immune signaling proteins (cytokines) flood the body and can trigger skin lesions and pain.
Direct viral effects also contribute. The SARS-CoV-2 virus uses the ACE2 receptor to enter cells, and these receptors are present in skin cells, particularly keratinocytes and endothelial cells of blood vessels. Microvascular changes, such as small blood clots or damage to tiny blood vessels in the skin, result in reduced blood flow, causing discoloration and pain, as seen in conditions like vaso-occlusive lesions and potentially contributing to “COVID toes.” Neurological impacts, including inflammation or damage to peripheral nerves, explain the tingling, numbness, and hypersensitivity sensations.
When to Consult a Healthcare Professional
If you experience persistent or concerning skin symptoms during or after a COVID-19 infection, it is advisable to consult a healthcare professional. Seek medical attention if skin pain is severe, rapidly worsening, or accompanied by other concerning symptoms like difficulty breathing, chest pain, new confusion, or inability to stay awake. Any new or unusual skin changes, especially those that are painful, blistering, or spreading rapidly, warrant evaluation.
Persistent unusual skin sensations, such as prolonged tingling, numbness, or hypersensitivity, should also be discussed with a doctor, particularly if they interfere with daily life. While many skin manifestations and pains related to COVID-19 are self-limiting, a medical assessment can help determine the cause and rule out more serious conditions. A healthcare provider can offer guidance on managing symptoms and ensure appropriate care.