Skin diseases associated with COVID-19

Patients with coronavirus disease-2019 (COVID-19) commonly present with headaches, loss of smell and taste, diarrhea, and breathing difficulties. Some patients may have significant complications that affect a majority of organ systems such as the central nervous system, intestinal tract, cardiovascular system, and skin. One percent to 20 percent of patients with COVID-19 have been reported to have one or more skin symptoms in China and several European countries. [Curr Opin Infect Dis 2022;35(2):88–94]

According to dermatologist Dr Vaani Valerie Visuvanathan, the most common skin condition linked to COVID-19 is morbilliform rash which resembles measles in appearance and consists of macules and papules. The rash typically develops within 2 weeks of COVID-19 symptom onset. Some macules and papules may overlap resulting in bigger patches of discoloration on the skin, especially on the trunk and resolve within 1 week. Patients have reported increasing itchiness over time. Morbilliform rash is widely prevalent in patients with various viral illnesses. [Cleve Clin J Med 2022;89(3):161–167]

Another form of skin condition, urticaria or hives, usually causes itchy red welts or wheals, said Vaani Valerie. Current evidence suggests that urticaria is associated with milder COVID-19 infection and may be the first sign of infection. On average, urticaria resolves within 1 week and has been found in 105 out of 895 COVID-19 patients. Urticaria has also been linked to gastrointestinal symptoms.

Vesicles, another type of skin manifestation associated with COVID-19, consist of tiny blisters similar to chickenpox. According to a study, vesicles have been documented in 18 out of 24 patients. Vesicles usually resolve in about 1 week and do not cause scarring. Vesicles, similar to urticaria, appear prior to other symptoms of COVID-19 infection. Vesicles have been linked to neurological symptoms such as headache, confusion, irritability, and dysgeusia (distortion of the sense of taste).

Additionally, some COVID-19 patients have developed a condition referred to as “COVID toes,” which is often referred to as pseudo-chilblains and causes the development of painful chilblain-like lesions. These lesions typically resolve within 2 weeks, are non-scarring, and are often accompanied by itch. COVID toes appear to be more prevalent among younger patients, primarily children.

Treatment of skin diseases associated with COVID-19
For morbilliform rash, it is recommended to prescribe steroid creams and antihistamines. Antihistamine is also prescribed for urticaria since both diseases are types of rashes. However, patients should be advised to seek medical attention if they have vesicles. For COVID toes, painkillers such as paracetamol can help with managing the pain, said Vaani Valerie.

If patients have any signs of redness spreading on their skin and/or severe acne breakouts, they should be strongly advised to seek medical advice preferably from a dermatologist. They must be warned that using off-the-shelf products for severe acne breakouts can cause more damage, said Vaani Valerie.

COVID-19 vaccine safe for patients with skin diseases
Hesitancy to receive the COVID-19 vaccine may arise especially in patients with underlying skin disorders. Research was conducted on the possibility of the COVID-19 vaccine causing the skin conditions, including morbilliform rash, urticaria, vesicles, and COVID toes. Results from the research showed that there may be occasional side effects, but it is more apparent among patients who already have eczema prior to taking the COVID-19 vaccine, said Vaani Valerie.

There were also cases where patients with eczema experienced flare-ups after receiving the COVID-19 vaccine, but they were easily managed. Also, having eczema does not worsen COVID-19 symptoms and taking the vaccine will only reduce the chances of contracting COVID-19, said Vaani Valerie.