Skin rashes can appear in children following a COVID-19 infection. While less common than respiratory signs, skin changes are a recognized symptom of SARS-CoV-2 infection in pediatric patients. Understanding the different forms these rashes can take helps parents recognize them.
Common Types of Post-COVID Rashes
One common skin manifestation is the maculopapular rash, which presents as flat, red spots and small, raised bumps. This rash often appears darker on individuals with darker skin tones and is commonly found on a child’s trunk, arms, and legs. Another type is the urticarial rash, also known as hives, characterized by raised, itchy welts that can emerge and vanish rapidly. These welts can vary in size, from small spots to larger patches, and may be red, purple, or match the skin’s color. Individual hives typically resolve within minutes to 24 hours.
Chilblains-like lesions, often referred to as “COVID toes” or “COVID fingers,” involve red or purple, swollen areas on the toes and fingers that may be painful or itchy. These lesions can resemble frostbite and are seen more often in children and young adults. A less common presentation is the vesicular rash, which consists of small, fluid-filled blisters. This type of rash can look similar to chickenpox and usually appears on the trunk.
Timing and Duration of Rashes
Rashes related to COVID-19 in children can emerge at various points during or after the infection. Some rashes may appear during the acute phase of the illness, such as maculopapular rashes and urticaria.
In contrast, chilblains-like lesions, or “COVID toes” and “COVID fingers,” typically develop a few weeks after the initial COVID-19 infection. Most COVID-related rashes tend to last anywhere from 2 to 12 days. Maculopapular rashes generally subside within 10 days, while hives usually do not persist for more than a week. Vesicular rashes commonly resolve in about 8 days, though chilblains-like lesions can last for several weeks.
When to Seek Medical Attention
Parents should be aware of warning signs that suggest a serious rash requiring prompt medical evaluation. One serious, though rare, complication is Multisystem Inflammatory Syndrome in Children (MIS-C), which typically develops 2 to 6 weeks following a COVID-19 infection.
Symptoms of MIS-C include a persistent high fever lasting more than 24 hours, often for several days, accompanied by severe abdominal pain, vomiting, or diarrhea. Other signs can involve red eyes, dizziness, fatigue, swollen hands or feet, and enlarged lymph nodes in the neck. The child’s lips or tongue might appear bright red or swollen. Signs of reduced oxygenation, such as pale, gray, or blue-colored skin, lips, or fingernails, alongside confusion or difficulty staying awake, are concerning indicators.
Other red flags that warrant medical attention include a rash that spreads rapidly, becomes blistered or painful, or is accompanied by difficulty breathing or chest pain. Signs of severe dehydration, such as poor drinking or eating, or localized infection, like pus, increasing redness, or warmth around the rash, also necessitate professional evaluation. Parents should contact their pediatrician if they have any concerns about a new rash.
Managing Rashes at Home
For common, non-serious post-COVID rashes, most will clear up without specific medical treatment. Parents can implement several measures to help keep their child comfortable. Lukewarm baths can be soothing, and using gentle cleansers along with loose-fitting clothing can help prevent further irritation to the skin. It is also advisable to avoid products with added fragrances, such as soaps and lotions, if a child’s skin is particularly sensitive.
To relieve symptoms like itching, over-the-counter hydrocortisone cream or calamine lotion can be applied. Cool compresses may also help reduce swelling and alleviate itching. Oral antihistamines, if appropriate for the child’s age and after consulting a healthcare provider, can offer additional relief from itching. Applying moisturizing creams, such as Aquaphor Healing Ointment or Vaseline, can address dry and itchy skin. Throughout the course of the rash, it is important to monitor for any changes or worsening symptoms, and keeping the child’s nails short can help prevent scratching that might exacerbate the irritation.