Does covid-19 manifest on the skin?
One of the interesting questions to emerge around covid-19 in recent weeks is if there are any skin manifestations of the virus.
As time has gone on, our colleagues in the UK and around the world have tried to understand this invisible enemy in depth to stand us in better stead to diagnose the condition early, to try to find a treatment and develop a vaccine.
Dr Recalcati, a dermatologist based in Lombardy, an area that has been affected dramatically by the virus, was deployed to the front line to help triage suspected patients. They looked at possible skin manifestations that could help doctors suspect covid-19, along with shortness of breath and fever, to help diagnosis and offer appropriate advice.
They set out to examine 148 confirmed covid-19 in-patients in Lecco, of which they excluded 60 patients, as they had started new medication in order to rule out acute drug reactions (ADR). Of the remaining 88 patients, 20.4% (18 patients) had developed cutaneous manifestations.
They observed that 10 patients developed a rash after hospitalisation and eight patients had skin eruptions at the onset of their other symptoms.
They described the rashes, noting that 14 patients had an erythematous exanthem, three had widespread urticaria and one had chicken pox-like vesicles. Moreover, the most affected area was the trunk. Interestingly, the skin eruptions did not correlate with disease severity.
Meanwhile, a large study from Spain looking at 375 patients described five common skin manifestations of covid-19:
- Maculopapules (47%)
- Acral Pseudo-chilblain (19%)
- Urticarial lesions (19%)
- Vesicular eruptions (9%)
- Livedo or necrosis (6%)
The authors concluded that vesicular eruptions seemed to appear early in the disease. Acral pseudo-chilblains appeared asymmetrical (“covid toe”) towards the later stages, more commonly in younger patients, as well as being associated with a less severe form of the disease.
The remaining three manifestations were noted to appear along with other symptoms of the virus. There have been other reports of drug hypersensitivity, urticaria, a petechial rash that mimicked dengue, and acral ischaemia in children.
It is important to remember these presentations are similar to other viral infections, drug reactions and unwell patients. More studies are required to see if there is a link – the American Academy of Dermatology (AAD) has launched an online covid-19 dermatology registry to try and collate these cases and determine any links.
Fundamentally, one must not assume that a rash presenting during this time is solely synergistic with covid-19.
Dr Ravi Brar is medical director of sk:INSPIRE Medical Aesthetics. He graduated from Guys and St Thomas Medical School and is a member of the Royal College of General Practitioners. He has a special interest in dermatology, having completed postgraduate studies in Clinical Dermatology from Queen Mary University London, with a distinction. His patient-centred ethos is to naturally enhance and define, helping his patients to look and feel their best. He prides himself on a holistic approach, ensuring that the patient is also educated on their skin.
