A new, raised red rash and unexplained marks on the skin could be signs of Covid-19, experts have warned. Data from Italy indicates as many as one in five people hospitalised with Covid-19 may develop rashes or experience changes to the skin.
In some cases, a rash could potentially be the first – or only – sign of infection. According to the NHS, the main symptoms of the coronavirus are a new and continuous cough, and a high temperature.
However, it has been estimated that up to eight out of ten people infected may experience only mild, or show no symptoms of the illness at all. And, as cases rise, multiple additional symptoms have been linked to the virus.
The World Health Organisation says diarrhoea, a sore throat and aches and pains can indicate infection. In the UK, ear, nose and throat specialists have warned that a loss of smell, know as anosmia, and often taste could be a symptom.
‘I have seen quite a few patients who don’t normally suffer from eczema or allergies who have a sudden, odd rash,’ says Dr Veronique Bataille, an NHS consultant dermatologist.
‘Then, maybe two or three days later, they have developed typical Covid-19 symptoms. For some patients, we believe a rash may be the only symptom that they get.
‘The public should look out for this and other possible symptoms in members of their household.’
A study of 88 infected patients at the Lecco Hospital in Lombardy, one of the hardest-hit Italian regions, found 20 per cent experienced changes to their skin.
None of them had taken drugs that could have caused the reaction. Eight out of the 18 patients who noticed changes to their skin did so at the onset of their symptoms.
Doctors have also reported chilblains – red patches on toes and fingers usually caused by cold temperatures – in some coronavirus patients.
‘The skin is the largest organ in the body – and it’s visible,’ says Professor Hywel Williams, co-director of the centre of evidence-based dermatology at the University of Nottingham.
‘So if you are very unwell, and your lungs are sick, it’s not surprising really that the skin reacts in some way in about a fifth of cases.’
In fact, it is common for any virus, including the one that causes Covid-19, to trigger skin rashes. But, unusually, the rashes detected in Covid-19 patients seem to vary significantly in appearance.
Scientists don’t yet fully understand why these rashes occur. But it is thought it could be a side effect of the immune-system trying to bring the infection under control.
Dalia Dawoud, 46, from North London, first noticed a red rash on her body five days after her husband, 51, began showing Covid-19 symptoms. The rash resembled chicken pox but with smaller, less itchy pimples.
Her husband, an A&E consultant in the NHS, had already tested positive for the virus, and her daughters, aged 11 and 17, were also showing symptoms, so her illness did not come as too much of a surprise.
But the rash, which is not mentioned in NHS Covid-19 guidance, was unexpected.
Dalia, a scientific adviser, says: ‘I didn’t have any of the flu-like symptoms. This rash was the first thing to appear.’
After a few days, Dalia developed a mild cough and fever, which quickly passed. But her rash persisted for about a week, and she suffered on and off with fatigue and headaches for a fortnight.
More research is needed to determine if the skin conditions are definitely linked to Covid-19.
The American Academy of Dermatology, which represents thousands of dermatologists, is already gathering data from doctors around the world.
If a link is proven, it might be an important development in controlling the disease, as experts believe rashes could help to identify people who may be infected and should be tested for the virus.
Dr Jeremy Rossman, honorary senior lecturer in virology at the University of Kent, says: ‘The fever might not start until later in the disease in some patients, and others might have a rash, or gastrointestinal symptoms earlier on.’
But Dr Bataille stresses that a rash is not necessarily something to be concerned about, especially if a patient has reacted in a similar way in the past.
Any new rash should in adults or in children should be discussed with a GP promptly.