- We’re still learning all the ways that the novel coronavirus affects our bodies.
- Though we started out thinking of the disease as something that primarily attacks the lungs, other symptoms — like the loss of taste and smell, dizziness, and nausea — are coming to light.
- Dermatologists are now learning that the virus may show itself through skin problems, the most well known of which is toes that look as if they’re frostbitten, also known as “COVID toes.”
- The American Academy of Dermatology has received over 600 submissions of skin-related problems that healthcare providers are seeing in patients with COVID-19, including “COVID toes,” rashes, hive-like symptoms, and blisters that resemble chickenpox.
- Many of the new skin problems aren’t exclusive to the coronavirus, meaning that even if you see them, you don’t necessarily have the virus.
- Read live updates about the coronavirus here.
There is still a lot that we don’t know about the novel coronavirus.
We originally thought of it as a virus that primarily attacked the lungs. After all, a cough and shortness of breath are some of the key signs of infection.
But the virus affects different people in different ways. Some may not have any symptoms at all, while others can be so sick that they need to be hospitalized. There’s also mounting evidence to suggest that the elderly and children may have vastly different symptoms than the rest of the population.
COVID-19, the disease caused by the coronavirus, also reveals itself through skin problems, doctors are now learning.
The most well known is toes that look as if they’re frostbitten, also known as “COVID toes,” but others are still coming to light.
The American Academy of Dermatology (AAD) has been tracking the dermatological effects that COVID-19 patients are experiencing through a registry where healthcare providers can submit entries. The AAD has over 600 submissions so far from more than 25 countries.
“The pernio lesions or ‘COVID toes’ are certainly one of the primary things being reported” in the registry, Dr. Esther Freeman, a dermatologist and epidemiologist at Massachusetts General Hospital who’s managing the AAD registry, told Business Insider. “But we’re also seeing a lot of other skin manifestations as well.”
Freeman said some of the other skin findings in the registry include morbilliform eruption, a non-specific viral rash that’s a common skin sign of many viruses and drug reactions; urticaria, also known as hives; and vesicular eruptions, which Freeman describes as “chickenpox-like” blisters on the skin.
“Our knowledge is really continuing to evolve about the timing of these different skin manifestations because it’s complicated,” Freeman said. “Not everyone seems to be developing them at the exact same time in the disease course. So I think we’re still learning a lot.”
Never miss out on healthcare news. Subscribe to Dispensed, Business Insider’s weekly newsletter on pharma, biotech, and healthcare.
Dr. Lindy Fox, a professor of dermatology at the University of California at San Francisco who is involved in the AAD’s registry, told Business Insider that it’s not surprising to see non-specific rash and hives, because they’re fairly common bodily responses to viruses.
The skin signs that stand out to experts
The skin symptoms that do stand out, Fox said, are COVID toes and vesicular eruptions (or blisters) because they’re not as common in patients with other viruses.
COVID toes are particularly unusual because they often appear after other COVID-19 symptoms have subsided and are more prevalent in patients with milder or no symptoms.
Read more: ‘COVID toes’ might be the latest unusual sign that people are infected with the novel coronavirus
As for the vesicular eruptions, Fox said the dermatology community is still working to figure out why they’re appearing in patients with the disease. There are only a handful of other conditions that cause similar blisters.
“COVID is now on that list,” Fox said. “So since that list is so short, it makes the likelihood of it being COVID in this day and age with COVID everywhere higher if you see that rash.”
Dr. Randy Jacobs, a dermatologist in California, told Business Insider that he’s been seeing something he calls transient livedo reticularis, red splotchy “net-like” skin discoloration, among some of his patients who have tested positive for COVID-19.
The interesting thing about this skin finding, Jacobs said, is how quickly it seems to appear and then disappear in his patients. The first patient who noticed the rash saw their condition clear up in 19 hours. Another saw it disappear in as little as three.
“It can come and last an hour and go away and people might not even see it,” Jacobs said. “They might not even notice it because it comes and it goes.”
From the outside, and even to experts, hives or rashes brought on by an allergy or by COVID-19 are impossible to tell apart. It’s only after taking a test that would show the presence of the virus or of antibodies that someone can be sure whether they have or had the disease.
“It’s important for people to understand that but just by looking at the skin, we are not going to be able to tell you if you’re infectious,” Freeman said. “It might give you a clue of potential COVID, but to really understand if it is truly COVID, you would need a test.”
If someone is developing a rash they’ve never had before, they should contact a dermatologist or other healthcare provider to be evaluated, Freeman said. A doctor would be able to figure out whether there could be another cause for the skin changes and help get that person tested for the coronavirus.
Dr. Joanna Harp, director of the inpatient dermatology consult service at Weill Cornell Medicine and NewYork-Presbyterian Hospital, has been assessing skin findings in COVID-19 patients since the start of the pandemic. She told Business Insider in an email there were a variety of rashes among hospitalized COVID-19 patients.
“The main finding we have noted is a pattern of lacy, red-purple rashes, some with skin necrosis, on the arms, legs, and buttocks in critically-ill COVID-19 patients,” Harp said.
Doctors have seen through skin biopsies that the skin problems in more severe COVID-19 patients are brought on by clotting in the small blood vessels in the skin. Often, those patients also have blood clots in their legs or lungs, or have had strokes, indicating clotting problems throughout their bodies, Harp said.
There’s evidence to suggest that such patients would benefit from blood thinners, but Harp says that decision is made on a case-by-case basis.
Read more: Companies are scrambling to figure out how to get employees back to the office safely. One of Silicon Valley’s favorite healthcare startups thinks it has the solution.
There are also other rashes like hives or bumps on the skin of some hospitalized COVID-19 patients, but Harp said it’s unclear whether these manifestations are from the virus itself or from medications that patients are getting to treat the virus.
“The skin may be a window into how differently patients’ immune systems can react when confronted with this virus,” Harp said.
COVID toes, for example, are possibly indicative of “a robust immunologic response to the virus,” as most patients often have minimal symptoms, Harp said. Skin symptoms brought on by blood clots on the other hand, could show “a heightened clotting tendency that really don’t seem to be able to control the virus.”
“The skin may have a lot to teach us about this disease,” she added.
At this point, it’s unclear how common skin problems are for patients with COVID-19 because we don’t know how many people are actually infected with the disease, partly because of limited testing.
—DermatologyACD (@DermatologyACD) May 6, 2020
Dr. David Francis, president of The Australasian College of Dermatologists, told Business Insider in an email that skin manifestations could be common in as many as 20% of COVID-19 patients. The figure comes from an early report by Dr. Sebastiano Recalcati, of Alessandro Manzoni Hospital, in Lecco, Italy, based on the patients he said he personally saw in his hospital.
Francis said that more research and collation of patient data was required to get a better understanding of the skin manifestations of the coronavirus.
Read more: How the coronavirus will permanently change healthcare, according to 26 top industry leaders
Though the AAD’s registry has collected hundreds of entries, Freeman said she’s reluctant to make any definitive statements based on what she’s seeing.
“Even if we see a certain proportion [of skin symptoms] in the registry, it doesn’t mean that that’s actually the proportion of skin filings that people are seeing,” Freeman said. “It’s just what people are reporting to us or what people are finding notable that they are choosing to report, rather than truly a representative sample of an entire population.”