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Coronavirus Rashes? Dr. Sandra Lee Fills Us In

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Coronavirus Rashes? Dr. Sandra Lee Fills Us In

COVID toes + Dr. Pimple Popper is a combo we never saw coming.

As the COVID-19 pandemic continues, doctors and researchers are learning more about the behavior and effects of the virus. We’re all aware that it’s a mainly respiratory illness; common symptoms include fever, coughing, and shortness of breath (if you have these, call your doctor please!). But more and more patients are exhibiting an unexpected symptom: skin rashes. We caught up with dermatologist Sandra Lee, MD (aka Dr. Pimple Popper), to find out more about these rashes, why they’re popping up, and when you should see a doctor.

TS

Are rashes a symptom of coronavirus infection?

SL

We are still learning every day about skin manifestations of coronavirus. I think it’s proving to be a true chameleon, with different skin findings in different people. It’s not unusual for a viral illness to have an accompanying skin rash. Sometimes the rash is unique and clues you into the diagnosis, like chickenpox rash or herpesvirus rash. However, the rashes we are seeing in coronavirus can occur in other medical conditions as well. 

TS

How common are the rashes?

SL

So far we suspect that 20% of people who have tested positive for COVID-19 show signs in the skin.

TS

COVID-19 is a respiratory illness — how does this result in dermatological symptoms?

SL

We suspect many of the respiratory or lung issues may have to do with problems with blood clotting, especially in the small blood vessels in the body. Similarly, many of the skin findings we are seeing that we strongly suspect may be tied to COVID-19 are due to blood clots in our vessels. Because this happens to the more superficial blood vessels, we can see evidence of this in the skin, such as a frostbite-type appearance to fingers and toes and a reticular or net-like patterned rash in the skin.

TS

What do the rashes look and feel like?

SL

We now have a term, “COVID toes,” that we use to describe the purplish/red slightly firm raised bumps that we are seeing occur on fingers and toes. This is seen in another condition called pernio, which can be seen independent of viral illness like coronavirus. However, it can be a sign of a hypercoagulable state, where you may develop small clots within your blood vessels. This cuts off proper blood supply to your fingers and toes, causing them to turn purple in color. 

“It’s not unusual for a viral illness to have an accompanying skin rash.”

TS

Do these rashes only appear on fingers and toes?

SL

Rashes are seen on many areas of the body. I don’t think we have found an area of the body which we are assured is devoid of a COVID-type rash. If these skin signs are due to the production of small blood clots, or microthrombi, this could possibly be seen anywhere in the skin. I mean, this could be occurring internally as well but we can’t see that right? We can only easily see each other’s skin, and we usually need radiographic studies or blood tests to detect changes within other organs of the body.  

TS

Who is most likely to get a rash?

SL

We are now thinking that these rashes are often seen in people who are otherwise symptomatic or had mild disease manifestations. We may also see them later on, or as a late symptom.

TS

Should I be concerned if I get a rash?

SL

If you have any rash that is new and unusual, and certainly if you have had a known COVID-19 exposure or think you have had coronavirus, please contact a board-certified dermatologist who can evaluate your rash.

Interview courtesy of Sandra Lee, MD

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