After a doctor shares images of a potentially coronavirus-induced skin rash, Health investigates.

By Taylyn Washington-Harmon
Updated July 22, 2020

With our incessant coronavirus-induced hand washing, it’s normal to get a mild rash on your hands. Rashes that come and suddenly disappear? Not so normal.

Randy Jacobs, MD, a California-based dermatologist, observed cases of a mystery rash in three of his patients diagnosed with COVID-19. What’s so unique about this rash is that it appears to come and go, unlike other rashes typically associated with a viral infection like chickenpox, measles, or even dengue fever. 

“What we’re seeing is transient livedo reticularis, a dermatological diagnosis that’s usually autoimmune related, and it looks exactly like what this photo shows,” says Dr. Jacobs, whose article on the findings is slated to be published in the Journal of the American Academy of Dermatology. “Normal livedo reticularis usually lasts a long time, sometimes it's even permanent. It's not something that comes and goes.”

Lara Devgan, MD, a New York-based board-certified plastic surgeon, shared photos of Jacobs’ findings on her Instagram profile after seeing the images circulate in a private doctors’ Facebook group, garnering over 100 comments from concerned doctors and patients. “One thing that has been very remarkable, especially in private physician social media groups and Listservs, is that there's a vast amount of information being shared very rapidly, and really helping to improve our algorithm in treating and managing coronavirus,” Dr. Devgan tells Health. “Coronavirus is a disease entity where our knowledge is rapidly evolving and we're building the ship as we sail it.”

The rash presents itself as tiny purple, red, or brown spots that one may mistake for bruising under the skin.

In Italy, where the coronavirus cases peaked in March, a small observational study of 88 patients shows that 20.4% of them developed some form of skin condition speculated to be related to COVID-19. “There is a possibility that a COVID-19 patient might initially present with a skin rash that can be misdiagnosed as another common disease,” reports Beuy Joob, PhD, of the Sanitation1 Medical Academic Center in Bangkok, who is co-author of another study investigating a COVID-19-related rash.

“It's not unique that a virus would give you a skin rash,” Mona Gohara, MD, a Connecticut-based dermatologist tells Health. “[Dr. Jacobs] may have identified a unique pattern that could be associated with COVID-19.”

Could a mouth rash be a sign of coronavirus?

Researchers in Spain have reported yet another type of rash, this one found in the mouths of hospital patients with COVID-19 and skin rashes. Of the 21 people in the study, six (or 29%) had an "enanthem" rash, meaning inside the body, specifically in their mouths. Four of the six were women. The rashes appeared, on average, just over 12 days from the onset of their COVID-19 symptoms. Five of them developed a type of rash that looks like tiny spots, called petechiae.

Reporting in the published the July 15 issue of JAMA Dermatology, the authors say the presence of a mouth rash, and petechiae in particular, suggests that the cause may be a viral infection, as opposed to an adverse drug reaction. Of course, one small observational study does not prove cause and effect. Much more study is needed. But it's another potential clue, one that may have been largely overlooked because, due to safety concerns, "many patients with suspected or confirmed COVID-19 do not have their oral cavity examined," the authors point out.

Is COVID-19 causing my skin rash?

So what causes a skin rash? Usually some skin irritation or exposure to an allergen can result in a skin rash that itches like eczema, which will be pretty common if you’re frequently washing your hands. 

In this unique case, this itch-free rash could be caused by your immune system’s response to the virus. “If [the rash] is transient (coming and going), what we suspect is that a bunch of viral particles are being released into the bloodstream at that particular moment,” Dr. Jacobs tells Health. “The rash itself is caused by a blockage of blood called vaso occlusion. When you block the blood, you don't get oxygen.”

Rachel Nazarian, MD, a New York-based dermatologist and fellow of the American Academy of Dermatology, attributes these rash patterns to poor circulation in relation to COVID-19, given that many patients are dealing with heart issues associated with the disease. “What we’re finding could essentially be little baby strokes due to decreased blood circulation, related to COVID-19’s ability to possibly increase the blood to clot.” Dr. Nazarian has also noticed these patterns in three of her patients, all who were considered relatively young healthy.

So what should you do if you encounter this specific rash? With any kind of chronic rash, always talk to your dermatologist to determine a potential course of treatment, one that may lead to COVID-19 testing. “There are doctors looking into how common this rash is,” says Dr. Jacobs. “Because a lot of people might not even notice it, especially if you’re wearing pants all day.”

