It was early last month that Lekha Das noticed rashes developing on her hands. Initially she put it down to a mild reaction to the shellfish dinner she had eaten. But when they began to become extremely itchy she contacted her doctor who did a detailed test to rule out not just a case of food allergy. He then tested her for Covid-19 infection. Fortunately, Lekha tested negative for the infection that is now wreaking havoc across the world.

Medical professionals across the globe are still facing surprises every day about the severity and the degree of variations in the signs and symptoms of Covid-19.

“One of the confusing aspects of this infection is the type of symptoms a patient displays. From children to healthy adults, pregnant women or the elderly, the signs of the infection vary from one individual to another,” says Dr Ikramullah Al Nasir, specialist dermatologist and medical director at Dermacare Skin Centre, Dubai. “While Covid-19 is mainly a respiratory infection, there can also be some sneaky symptoms people can miss out on and skin rashes is one.”

A recent study shared by King’s College London has highlighted that certain prominent skin rashes can be a significant typical sign developing Covid-19 infection, after cough, fever, anosmia (loss of smell) and breathlessness, he says.

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“The researchers of this study have discovered that about 9 per cent of people reporting a positive coronavirus swab PCR test had experienced a skin rash as part of their symptoms.”

Dr Ikramullah lists clinical patterns of Covid-related skin rashes:

Urticaria (Hives): These rashes can present quite early in the infection phase, but can also last even after the patient is no longer contagious. These rashes appear as sudden raised wheals (hives), which appear and disappear in a matter of hours and are usually extremely itchy. It can involve any part of the body. If it affects the face, it can cause swelling of the lips and eyelids. The eruptions can also start with intense itching of the palms or soles. In patients with lip swelling, it is important to check that they are not experiencing wheezing or difficulty in breathing as this would require urgent medical attention.

Prickly heat or chickenpox-type rash: Also described as red bumpy rashes, which usually persist for several days or weeks, they may occur anywhere on the body, but favour the elbows and knees, and the back of hands and feet. It can resemble a severe case of prickly heat and can be severely itchy. These rashes can appear during any time of the disease but are seen more commonly in the later period of the infection.

Covid fingers and toes (Chillblains): This is the most specific Covid rash as not many other skin conditions present in this way. In certain cases, it can resemble certain features of Chillblains, a skin condition which is mainly seen during extreme cold spells. It is more commonly seen in younger patients. The rash presents itself as reddish and purplish bumps on the fingers or toes and can affect many digits. The affected areas are usually very sore, but not itchy. In the recovery phase of the rash, the top layers of the skin show significant peeling. This type of rash is usually present in the later part of the Covid infection.

Enanthem (Covid-related oral cavity lesions): This relatively rare form of rash has been reported by Italian and Spanish groups of clinical researchers. The oral cavity is seen with multiple lesions mainly located in the palate area. However, lips may also feel sore and may be dry and scaly when they recover. The majority of patients showing these oral rashes are women. The appearance of these lesions was seen between 10-14 days of the infection.

Dr Ikramullah stresses the importance of keeping an eye out for any new changes to the skin, such as lumps, bumps or rashes. “Early reporting of Covid-associated rashes and recognition of their significance by frontline healthcare practitioners may increase the detection of coronavirus infections and help stop the spread,” he says.

Documenting skin symptoms associated with Covid-19 is an important piece of the puzzle in building our understanding of the disease. “Skin symptoms may play a crucial role in detecting infection in people who are otherwise asymptomatic, as in some cases a skin rash maybe the first or the only symptom of the disease,” he adds.

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