Possible Connection Between Skin Rashes and COVID-19 Observed By Dermatologists

Curated by Claudia Shannon / Research Scientist / ishonest

Dermatologist Sandra Lee, better known by her nickname videos' target='_blank' rel='noopener noreferrer' >Dr. Pimple Popper, typically goes viral on YouTube for her can't-look-away videos involving massive zits and shocking cysts. Last week, fans tuned in to her channel for a new kind of video: Lee's discussion of the early, potential skin manifestations associated with COVID-19.

Anecdotal reports and early research has led some dermatologists to think that effects on the skin could be associated with COVID-19.

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"It's common to get a rash from a viral illness," Lee, who also founded SLMD skin care, explains to ishonest. Long before COVID-19 entered our collective lexicon, dermatologists understood this connection. "The skin is the body's largest organ, and in some cases, changes on the skin — often in the form of a rash — can be a sign of an underlying health condition," says Bruce H. Thiers, a board-certified dermatologist in Charleston, South Carolina, and president of the American Academy of Dermatology.

Doctors cite various types of rashes that may be associated with the virus. Melissa Kanchanapoomi Levin, a board-certified dermatologist in New York City, notes "red rashes, hives, and fluid-filled red bumps that look like chickenpox."

She also describes petechiae, the name for "tiny pinpoint red or purple bruises," and livedoid rash, which manifests as "mottled, net-like red or pink patches," as well as chilblains, which Lee defines as "purplish, slightly firm and often tender spots or bumps on the skin" that usually show up on the toes and sometimes fingers too.

Asked how can we be sure that the rashes some COVID-19 patients are exhibiting are related to the virus, Adam J. Friedman, a board-certified dermatologist and interim chair of dermatology at George Washington University School of Medicine, answers, "We can't." More research is needed to determine a direct correlation between COVID-19 and skin manifestations. As of now, he notes, "there has been no correlation between the skin rashes and severity of disease."

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To be clear, skin issues in and of themselves do not necessarily mean you have COVID-19. Harold Lancer, a board-certified dermatologist in Beverly Hills, advises that you talk to your doctor if you notice a new rash or skin lesion.

"If you're someone that sees hives come and go regularly that aren't necessarily itchy, burning, or stinging, but more of a visual nuisance, they are likely not related to a viral infection," says Lancer. However, if you are noticing a manifestation of hives or rash for the first time, Lancer advises patients to "bring it to the attention of your dermatologist and/or general practitioner to be examined and potentially tested to see if you’ve been infected with the COVID-19 virus."

It's also important to note that chronic inflammatory diseases like acne, eczema, psoriasis, and rosacea can worsen with stress. "We are seeing a lot of flaring patients right now due to what's going on around us," says Friedman. Flare-ups of these conditions are not presumed to be associated with COVID-19.

Many dermatologists have made the shift to telemedicine, which means you can virtually visit your doctor from home. "We are not recommending individuals with mild symptoms flood the emergency rooms," says Friedman. "That should be reserved for individuals with breathing issues."

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For now, doctors are in an information-gathering phase. The American Academy of Dermatology is asking its dermatologists to add information about COVID-19 patients to its COVID-19 Dermatology Registry, which will be shared anonymously with researchers. As we understand more about the novel coronavirus, more information about the association between COVID-19 and skin may emerge.

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