'COVID Toes' And Other Rashes Leave Doctors Scratching Their Heads

Researchers say five skin conditions may be caused by COVID-19 or from a secondary virus, according to a study released this week.

This research builds on other small studies around the world, all examining the role of rashes in the pandemic.

Dermatologists carried out a study on 375 patients in Spain, in bid  to better understand how the latest strain of coronavirus manifests in skin symptoms.

Well-known COVID-19 symptoms include a fever, cough, sore throat,  and shortness of breath, but what has been dubbed  "Covid toes", unusual skin rashes and the loss of taste and smell are rarer symptoms.

Image: British Journal of Dermatology

Children appear to mainly be affected by frostbite-like lesions that are appearing on toes, yet in some cases they also appear on hands. These children tend to be diagnosed with mild cases of COVID-19, or are entirely asymptomatic.

It remains unclear whether these cases are symptoms of the coronavirus or the result of a secondary virus also carried by the patient, the research published in the British Journal of Dermatology concluded.

It is not uncommon for a rash to be a symptom of a virus, although the dermatologists said they were surprised to see so many varieties of rash with COVID-19.

"It is strange to see several different rashes - and some of them are quite specific," Dr Ignacio Garcia-Doval told the BBC.

It usually appears later on, after the respiratory manifestation of the disease - so it's not good for diagnosing patients.

Garcia-Doval said the most common form of rash in the study was small, flat and raised red bumps generally found on the torso - also known as maculopapular.

The most commonly seen rash in the study affected nearly half of the patients. Image:  British Journal of Dermatology

Dermatologists in Spain were asked to share details of coronavirus patients they had seen who had developed rashes in the previous two weeks. There were 375 in total.

These findings build on earlier studies of reddish, purple lesions and inflammation on people's feet and bodies observed in Covid-19 patients overseas.

In one report from Italy, 20 per cent of the patients had a skin rash, half at the onset of illness, and the other half later.

Italian doctors also found there was not one specific type of rash with some like hives, while others were described as “chilblains” or “pernio,” with frostbite-like lesions.

The researchers studied 88 COVID-19 patients at Lecco Hospital, in Italy's Lombardy region, and the torso was the most affected area with lesions usually healing in a few days.

A group of US dermatologists is also expected to publish an in-depth look at Covid-19’s effects on the skin. This will be based on  300 patients confirmed or suspected of having the virus.

In March, a research letter published in the Journal of the European Academy of Dermatology and Venereology was the first time doctors raised concerns about the virus' impact on the skin.

The World Health Organisation still does not recognise rashes and "COVID toes" as a symptom and says more work needs to be done to get to the bottom of the significance of these rashes.

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