COVID: Rash confirmed after COVID-19 infection

Since the beginning of 2020, the world has been kept on tenterhooks by the COVID-19 pandemic. COVID can affect not only the lungs but also other organs such as the heart, kidneys, or skin. Various studies confirm the connection between COVID and rashes on the skin. The usually reddish to bluish COVID rash can occur before, during and after infection with the coronavirus and can be quickly relieved with the right treatment. Medicated neurodermatitis creams help to heal the rash. 

COVID: Rash as an indication of infection before a positive COVID-19 test

Rashes on the skin can be the first diagnostic sign of a COVID-19 infection. In a study from Spain, 375 patients with rashes and other COVID skin diseases were examined more closely. Although in most cases the COVID rash in adults occurred during or after COVID-19 infection, there were 22 patients who had observed the COVID rash in adults before confirmed COVID-19 infection. 

Six typical skin disorders preceding a positive COVID-19 test

Most commonly, a reddish, itchy rash was observed before the presence of a positive COVID-19 test as an indication of COVID-19 infection. COVID toes, which are accompanied by reddish to blue "pseudo-frost bumps", are also considered a typical sign of a COVID-19 infection.  

Skin changes and rash during COVID infection

The COVID rash was most observed during COVID-19 infection. In a Spanish study, 212 out of a total of 375 patients noticed the rash during the COVID infection.

However, doctors observed that patients who suffered from a rash during COVID disease usually had a mild course of sickness. Consequently, the hospitalization rate and the number of deaths associated with a COVID rash in adults are rather low.

But what does COVID rash look like? Basically, a distinction is made between skin changes that generally occur frequently in infectious diseases and those that are typical of COVID-19 disease. The latter are divided into five different symptoms during a COVID infection:  

Chickenpox and measles-like rashes

In an Italian study with 375 patients, rashes resembling chickenpox were observed in 9 percent of the participants. However, contrary to the typical symptom of chickenpox, itching rarely occurred with COVID rash in adults. Like "real" chickenpox, the red spots often appeared on the trunk as well as the arms and legs.

In another study with 88 participants, about 20 percent had a rash like measles. Here, too, the rashes were rarely accompanied by itching.

Reddening and nettle-rash with COVID

Reddening of the skin can occur because of almost all infectious diseases. Typical symptoms here are hives (urticaria), where reddish spots or wheals can be observed on the skin. In many cases, urticaria is also accompanied by itching. In most cases, these COVID skin rashes only occur for a short time and then disappear again.

Bluish skin lesion (livedo reticularis)

Another skin lesion during COVID-19 disease is bluish markings on the skin due to lack of circulation. Two cases have been documented in US medical journals. In both cases, the bluish skin changes were short-lived, lasting 20 minutes and 19 hours, and were observed ten days after the first corona symptoms.

Chilblain-like skin rash with COVID

In the previously mentioned study from Spain with around 375 participants, a chilblain-like lesion was observed in 19 percent of the patients. This COVID rash was observed more often in children. The median age was 16 years. In another study with 58 participants, 38 people who tested negative for COVID-19 had a chilblain-like rash as a symptom. This indicates that this rash is not a unique indicator of COVID disease and may also be due to other infectious diseases.

Necrosis during COVID infection

Only in very rare cases and in severe courses can necrosis develop because of a COVID-19 disease. In this case, skin cells die, and the tissue turns dark. Severe pain can also occur. If the necrosis is very severe, the tissue must be removed.

Skin changes and rash after COVID infection

A skin rash after COVID is also often observed. In Spain, for example, 139 out of 375 patients were (still) affected by the skin changes described above even after they had overcome COVID-19. In most cases, however, the COVID skin rash improved within a few weeks after infection.

Another study also shows that the COVID-19 patients treated as inpatients had changes in the skin, and in some cases these changes persisted after recovery.

In such cases, it should be clarified whether the skin rashes are due to COVID-19 disease or to side effects or allergic reactions to drugs taken. Because of the weakened immune system, an infection with the coronavirus can also aggravate already existing chronic inflammatory skin diseases. If the specific trigger for the COVID skin rash is identified, a targeted therapy against the rash can be carried out.

COVID rash with Omicron  

Since the Omicron variant, a rather mild course of the disease with a lower hospitalization rate than the Delta variant has been observed despite high infection rates.

As the COVID rash tends to occur in milder courses, a connection between the rash and the Omicron variant can be assumed. Also, more and more cases of skin rash are reported after Omicron infection, even long after recovery.

Although studies confirm that skin symptoms of COVID-19 infections occur in five to 20 percent of COVID patients, there are currently no reliable studies and data for the clustered Omicron skin rash. 

Is COVID rash a Long COVID effect?

Long COVID is the term used for all symptoms of COVID disease that persist for more than four weeks after infection with the coronavirus or that first appear after this period.

A survey study evaluated about 1030 COVID-19 cases in over 41 countries to find out how long a rash or other skin disorder persists after infection. The study came to the following conclusions:

COVID rash: Children also affected

The studies on children in connection with the coronavirus are limited. On the one hand, this is because only two percent of those who tested positive are children. On the other hand, the COVID-19 infection in children often runs without symptoms. Thus, only a few studies exist that associate a COVID rash with children.

What does COVID rash look like in children?

In a study in Spain, 62 children were examined. The average age of the children was 10 years and almost 60 percent of the participating children were male. All the children and their parents were tested for COVID-19 infection with an antibody or PCR test. Most of the children had typical COVID-19 symptoms such as cold and cough, as well as naturally noticeable skin conditions.

The children were divided into two groups. The first group was infected with the coronavirus according to the test results and examinations. The other group of children presumably only suffered from similar symptoms but were not infected with COVID-19 and thus did not have a positive test result.  

The study concluded that the symptoms of skin rash are more severe and frequent in children infected with coronavirus.

In the study, a red, blotchy, itchy skin rash was found in about 42.3 percent of children. Thereby were:

In 26 percent of the children, the skin lesions were very different and therefore could not be grouped. 

Reasons for the COVID rash

The exact causes of a skin rash due to a COVID-19 infection have not yet been conclusively determined. However, there are indications as to what the triggers for the skin rash during a COVID infection may be:

Occlusions and constrictions of the blood vessels

Prof. Dr. Matthias Muth, the head physician for dermatology in a clinic in Innsbruck, talks in an interview about the fact that generally skin diseases can occur as a result of infectious diseases.

COVID-19 disease can also lead to occlusion and constriction of the blood vessels. As a result, there is a lack of blood flow to the skin, which then manifests itself as a mostly bluish or reddish discoloration of the skin.

Herpes virus and Covid-19 diseases

If typical skin diseases occur around the mouth or lips as well as in the genital area, it could be due to a herpes reaction. It is known from various studies that a COVID-19 infection can activate herpes viruses. Consequently, the herpes disease is more likely to break out and show the typical symptoms.

Treatment of COVID rash

In most cases, the rashes caused by a COVID infection disappear by themselves within 14 days. However, especially in children, it is still important to treat the rashes effectively and quickly. In this case, a doctor should always be consulted beforehand, as he or she will make the diagnosis and prescribe appropriate medication to alleviate the symptoms.

Stop itching immediately with creams and gels

If an itchy rash occurs after COVID, children tend to scratch themselves. This can cause open wounds that can become infected and complicate the course of the disease. It helps to apply cooling creams and gels to relieve the itching. In addition, cold compresses can be applied to the affected parts of the body. It is important not to scratch the itchy COVID rash. Overnight, a neurodermatitis overall can be useful against scratching in COVID rash for children.

Ointments containing cortisone against COVID rash

Ointments containing cortisone are generally used in the treatment of skin diseases caused by infectious diseases. Thus, they are often used in the treatment of skin rashes due to COVID infection. The cortisone inhibits the inflammation on the skin and leads to a decrease in itching. However, cortisone weakens the immune system, which is not optimal in the therapy of COVID-19 disease. Moreover, cortisone preparations are only available on prescription and must be prescribed by a doctor.

In scientific studies and case reports, a severe skin rash due to COVID and other skin diseases due to COVID infection have been treated with cortisone preparations. Thus, it is advisable to seek medical help if needed.

Pimecrolimus or Tacrolimus

When treating sensitive areas such as the face, lips, or genitals, it is preferable not to use an ointment containing cortisone, as the effect may be too strong. As an alternative, treatment with pimecrolimus or tacrolimus can be considered. These medications also require a prescription. Therefore, a visit to the dermatologist is recommended in advance.

Natural household remedies

Unless a doctor's appointment can be arranged immediately, for example because the corresponding skin conditions occur at night or abroad after the COVID infection, natural alternatives can help to treat the COVID rash in an emergency:

Aloe vera: The liquid of the leaves of the aloe vera are a popular household remedy for skin rash. If you do not have a plant at home, you can alternatively apply an aloe vera cream or gel. Aloe vera inhibits itching and the preparations are available over the counter.

Olive oil: Olive oil can be used for very mild rashes and for prevention. The oil moisturizes the skin and has an anti-inflammatory effect. The use of olive oil is particularly suitable for very dry skin.

Foam creams and skin ointments

Foam creams can also be used without a prescription to treat the COVID rash. They relieve itching, repair the skin, and provide it with the necessary moisture.