Dermatologists around the world have noticed that there are skin findings associated with COVID and it’s important to present to you what we have seen because we know that if you are aware of this we may be able to slow the spread, maybe even help to diagnose COVID19 in the first place.
Let me present to you what we think we know so far, and this is NOT to scare you but to educate you. If you notice a NEW skin eruption on yourself or someone you are in close contact with, this could be your first or maybe only indication that you have COVID-19, and you may be able to help limit spread of the virus and even more importantly, help prevent the death or suffering of a loved one because you acted early.
There are at least two rashes we dermatologists have recognized to be associated with COVID19.
This first rash presents as a livedoid pattern - that being a red or purple-colored, mottled, reticulated, or netlike coloration pattern to the skin-“livedoid”. VERY IMPORTANTLY though, it must be pointed out is that some individuals can have this type of rash as a normal finding for them, so this rash is not specific for COVID-19. Livedo pattern can also occur in many other medical conditions that may or may not be worrisome that are unrelated to COVID19. However, in the world we live in today, if one were to notice this pattern of coloration on their skin for the first time in their life, this could be significant and raise the suspicion for COVID-19, especially if you have a known exposure to COVID or have other flu like symptoms.
We think patients with COVID19 are getting this kind of rash because there could be something awry within their small blood vessels, as this skin pattern can be a sign of small blood vessel occlusion - petechiae, bruises, ulceration, transient and blanching livedoid / reticulated eruptions. Certainly if you’ve developed a new and concerning rash, especially in the setting of suspected or known COVID19 infection, please contact your board certified dermatologist. Remember many of us are doing teledermatology so we can help diagnose many skin conditions via video appointment.
The second skin presentation we are seeing is called pernio, also called chilblains. This usually presents on the toes more often then the fingers with purplish slightly firm and often tender spots or bumps on the skin in these locations. Interestingly, we are noticing this in younger and often ASYMPTOMATIC individuals. This could possibly be the first and ONLY indication that a person has been infected with COVID19. Importantly note, if you have this condition it doesn’t confirm that you have COVID19 by any means. Pernio/chilblains most frequently is seen as a response to extended exposure to cold and damp conditions, and can be completely benign, or maybe signify an underlying autoimmune condition. So there are certainly people that get this that do not have COVID-19 What’s important for you to keep in mind is, If this is a new onset condition for you and you suspect you have been exposed to a person with COVID infection, this may be an early sign of the disease in you.
We THINK it makes some sense these two skin presentations occur with COVID because we think COVID is causing a transient low grade DIC (disseminated intravascular coagulation) causing microvascular occlusion. This essentially means we think the virus is causing widespread microscopic clotting /clogging within our blood vessels that can have its most harmful effects within our smallest vessels where it can lead to occlusion of these vessels and resultant death to the tissue that blood vessel supplies. Cold may play a role as well which may explain why we see it in our distal extremities (hands / feet) and even in our superficial vessels of our skin where our body temperature may be lower.
So what does this all mean for you? What if you notice a new skin rash like the pictures I’ve shown you? Contact your board certified dermatologist or your primary care provider;
These skin findings COULD be your first or maybe even ONLY indication that you have COVID19.
Link to recently published articles on Dermatology & COVID-19: https://www.jaad.org/content/collection-covid-19
If you are a physician and have COVID-19 patients with skin findings, please add them to the AAD Covid Registry: www.aad.org/covidregistry
MANY Dermatologists have contributed patient photographs and clinical experiences and THEY are the ones who should be thanked!
Randy Jacobs, MD; Sarita Nori, MD; Ivienson Manalo, MD; Jennifer Martin, MD; Molly Smith, MD; Michelle Tarbox, MD; Carlos Ricotti, MD; Dana Correale, MD; Samantha Carter, MD; Chelsea Houthoofd, MD; Karen McGinnis, MD; Jennifer Nash, MD; Lisa Donofrio, MD; Michael Contreras, MD; Tina Kinsley, MD; Mariana Atanasovski, MD; Katherine Nolan, MD; Curtis Asbury, MD; Sarika Snell, MD