While COVID-19 is primarily known as a respiratory illness, it can also cause various skin symptoms, including different types of rashes. These skin changes indicate the body’s response to the virus, and in some instances, a rash may be one of the only signs of infection. Their appearance varies significantly among individuals.
Understanding Different COVID-19 Rashes
COVID-19 can present with several distinct types of rashes, each with specific visual characteristics and common locations.
The most frequently observed is the maculopapular rash, which appears as flat, red patches and small bumps scattered across the skin, often resembling measles. This rash typically covers the trunk and can extend to the extremities, sometimes accompanied by itchiness. The coloration can range from red or pink on lighter skin tones to purple or brown on darker complexions.
Urticarial rashes, commonly known as hives, are raised, itchy welts that can appear anywhere on the body. They can vary in size and may cause an itchy or burning sensation. Hives have been observed to precede other COVID-19 symptoms and are generally associated with milder forms of the disease.
Pernio-like lesions, often called “COVID toes” or “COVID fingers,” are painful, swollen, and discolored areas, primarily on the toes and sometimes the fingers. They typically appear as red or purple bumps that can be tender, itchy, or cause a burning sensation. These lesions are more common in younger individuals and are generally linked to a milder disease course.
Vesicular rashes are small, fluid-filled blisters that resemble chickenpox lesions. These clear vesicles are often clustered and most commonly develop on the trunk, face, and extremities. The lesions can be itchy or painful and may emerge before other typical COVID-19 symptoms.
Livedo reticularis or racemosa presents as a mottled, net-like pattern of discoloration on the skin. This appearance stems from blood flow issues, leading to a web-like pattern that can be red or purple. These vaso-occlusive lesions are often seen in individuals with moderate to severe COVID-19 and have been associated with a less favorable prognosis.
When Rashes Appear and How Long They Last
The timing of COVID-19 rash appearance relative to other symptoms varies significantly. Some rashes may emerge concurrently with other symptoms, while others develop several days or weeks after illness onset. Certain types, such as urticarial (hives) and vesicular rashes, may appear before other common COVID-19 symptoms, potentially serving as an early indicator. In contrast, maculopapular rashes often appear after other symptoms. Pernio-like lesions can also appear after other symptoms or, in some instances, be the only symptom present.
The duration of these rashes also varies, typically lasting between 2 and 12 days, with an average resolution time of about 8 days. Some cases clear within a few days, while others persist for more than two weeks. In instances of long COVID, certain rashes can even last for several months. Urticarial rashes tend to resolve more quickly than other forms, while pernio-like lesions often last for a median of 14 days. Vesicular rashes usually evolve over 7 to 10 days before resolving, and maculopapular rashes generally subside within 10 days.
The type of rash can also provide insight into the potential severity of the COVID-19 infection. Hives and pernio-like lesions are generally associated with milder forms of the disease. Conversely, vaso-occlusive lesions, such as livedo reticularis, are more frequently observed in individuals with moderate to severe COVID-19 and may indicate a less favorable outlook. Maculopapular rashes are often associated with a less severe disease course.
When to Seek Medical Advice
If a new or unexplained rash appears, especially with other potential COVID-19 symptoms, consult a healthcare professional. Rashes can indicate many conditions, not solely COVID-19, so professional diagnosis is necessary. Visual identification alone is not sufficient to confirm a COVID-19 rash, and testing for the virus might be recommended.
Medical attention is important if the rash is accompanied by other concerning symptoms, including fever, pain, blisters, or signs of infection like swelling, warmth, or pus drainage. Immediate medical attention is necessary for severe symptoms like difficulty breathing, persistent chest pain, a rapidly spreading or significantly uncomfortable rash, blue or gray lips or nails, confusion, or difficulty staying awake. A rash developing weeks after a COVID-19 infection could also indicate multisystem inflammatory syndrome (MIS), a serious condition requiring prompt medical attention.