How Does COVID-19 Affect the Skin?

By Andrea Maderal, M.D.
Dermatologist
University of Miami Health System

As the COVID-19 pandemic develops, we’re learning how organs systems beyond the respiratory system are involved with infection. In the field of dermatology, we see more skin manifestations in infected patients.

These findings have been seen in other countries and here in the United States.

What can COVID-19 infection do to the skin?

 We see two kinds of complications.

The first is rashes related to the viral process. These rashes can start at the onset of your symptoms, but may also trail behind and appear well into a patient’s hospitalization for COVID-19. They look like widespread flat, pink scaly patches and raised spots. They may appear in clusters on all sides of the torso and extremities (arms, legs, hands, and feet), or may be widespread over the body.

Some patients also experience itchiness on the skin. Another manifestation we’re seeing in COVID-19 patients are hive-like lesions and widespread blisters.

The main challenge for us to diagnose these skin conditions is that they look and feel very similar to a reaction to certain medications. When this is a response to a drug (not the virus), we typically see the rash one to two weeks after the initial introduction of a new medication.

When a COVID-19 patient experiences these types of skin conditions immediately after starting a new medication, we can assume it’s in response to the virus (not the drugs).

We are also seeing skin rashes related to vascular insufficiency in COVID-19 patients. This means the patients are not getting enough blood flow to the skin due to clots (thrombosis) in the skin’s blood vessels.

What are doctors looking for on the skin when they examine COVID-19 patients?

• In mildly ill patients: perniosis — dusky or purple flat patches on the tips of the fingers or toes (mimicking frostbite)
• In moderately ill patients: maculopapular rashes — flat and raised skin lesions
• In critically ill patients: acral or distal digital gangrene — dead tissue on the fingers or toes

As we see and treat COVID-19 patients over the next few months, I expect to start seeing new expressions on the skin. My colleagues and I aim to be better able to assess and respond to a patient’s risk of serious disease based on some of these skin findings.

Tags: Andrea Maderal, COVID-19, dermatology, M.D