5 COVID Rashes: Pictures, Treatment, Dermatologist Advice

We usually think of COVID-19 as a viral disease that causes respiratory symptoms such as congestion, sore throat and cough. But like a surprising number of other viruses, the coronavirus can cause annoying, itchy and even painful skin rashes.

When you see a rash as part of a virus, you're not actually seeing how the virus gets directly into your skin, says Dr. Andrew Walls, assistant professor of dermatology at Harvard Medical School, told TODAY.com.

Instead, what you typically see is “the virus activating your immune system to a great extent as it fights the virus,” he explains. Although not a common symptom of COVID, a rash is another expression of your body's overall immune response to the virus.

And viral rashes aren't unique to COVID-19; Other viral diseases such as measles, chickenpox and hand, foot and mouth disease are often accompanied by a rash.

A rash associated with a viral infection is sometimes called a viral rash, says Dr. Jeffery Gehlhausen, Ph.D., assistant professor of dermatology at Yale School of Medicine, told TODAY.com. And the term encompasses an entire category of well-known skin diseases. “This (link) is something we’ve known about for centuries, honestly,” Gehlhausen said.

So if you develop a rash as a symptom of COVID-19, you're certainly not the first. Here's what to expect – and when you should talk to your doctor.

COVID rashes

Hives

Hives, also called urticaria, can be related to allergies. But they also occur after a viral infection, including COVID-19.

The condition may present as raised, itchy red, pink, or flesh-colored bumps. They can occur in isolated patches or large clusters. And they can occur virtually anywhere on the body, including the back, chest, legs, and face, says Walls.

Hives also “move around your body quite a bit,” says Walls. You could have hives for several days, but the hives could move from area to area, he adds.

When hives are related to a virus, they usually appear toward the end of the infection, Walls says. The timing typically goes like this: Someone feels quite ill and develops a fever. Then when the fever goes down and it looks like they're starting to take a turn, that's when the rash shows up, Walls says.

Beehives alone or even with COVID-19 are not necessarily worrisome, says Gehlhausen. If your hives need treatment, antihistamines are the first choice, he explains.

Morbilliform rash (like measles)

A typical viral rash is a rash that consists of smooth, raised pink dots that can cluster into larger patches, says Walls. The rash usually starts on the chest or back. Then it spreads to the extremities within a few days. (Some people only have a small area of ​​their body covered, while others have very large areas affected by the rash.)

The rash then peaks and “fades and flakes off, almost like a sunburn,” says Walls. For some, the rash is completely asymptomatic. But others are very itchy, he adds.

A specific type of viral rash that dermatologists have seen with COVID is a morbilliform rash, which is a measles-like rash. Measles rashes tend to look like small raised bumps that eventually merge into larger rashes that can affect much of the body before gradually disappearing, as TODAY.com has previously explained.

Coxsackie-like rash

Dermatologists have also observed COVID-related rashes similar to those caused by Coxsackie virus, also called hand-foot-and-mouth disease.

“These are firm, small, painful, sometimes itchy oval blisters that develop on the hands, feet, and inside the mouth,” explains Walls, “often without a major rash elsewhere.”

However, this is an “unusual skin manifestation in COVID,” Walls adds.

More recently, some strains of Coxsackie virus have caused “more unusual skin rashes that can affect a larger surface area of ​​the body,” says Gehlhausen. In other cases, the rash may affect less common areas, such as just the buttocks, he adds.

“Obviously COVID has evolved over time,” says Gehlhausen, “so there may be different distributions of the rash.”

COVID toes

You may remember a lot of conversations about “COVID toes” early in the pandemic. But dermatologists don't see something like that very often these days, experts say.

Chilblains — the technical term for COVID toes — is a skin condition that appears to be related solely to COVID and not to other viruses, Walls explains. “Sometimes it has been linked to autoimmune diseases… and it has been thought to be related to cold exposure,” he adds.

The condition causes small areas of skin on the feet and hands to swell, itch and hurt, according to the Mayo Clinic. Blisters may also form in the affected areas and become temporarily discolored.

These days, experts don't see COVID toes as often, they tell TODAY.com. This could be because people have stopped reporting that the virus has mutated and no longer causes the problem, or because there was never a link to it.

Currently, “researchers are still evaluating whether the swollen, discolored toes are caused by COVID-19,” says the American Academy of Dermatology. “It is possible for COVID toes to develop when the person’s immune system reacts to the virus that causes COVID-19.”

Vasculitis

Vasculitis is an autoimmune disease caused by inflammation of the blood vessels and can manifest as a rash.

Experts have seen some cases of vasculitis in COVID-19, particularly small cell vasculitis, which is the “least destructive” version of the disease, Walls says.

“We know that SARS-CoV-2 can affect the cardiovascular system and increase the likelihood of blood clots,” says Gehlhausen, so it is not surprising that we see vascular rashes in some patients. In general, he says, vasculitis-type rashes occur in people with more severe infections.

According to Walls, small cell vasculitis has also been linked to many other conditions, including bacterial infections (even strep throat) as well as antibiotics and other medications. “A variety of things have caused small vessel vasculitis in people,” he explains.

Fortunately, the condition usually occurs as a single episode that resolves on its own. But some people have cases that last for months or come back later, Walls says.

Can COVID trigger or worsen other skin problems?

In addition to causing skin rashes, COVID-19 infections can worsen pre-existing skin problems or trigger a recurrence.

According to experts, this also includes chronic skin diseases such as psoriasis and eczema. Interestingly, these can flare up again even after a COVID-19 vaccination, says Gehlhausen.

HSV (herpes simplex virus) illnesses, including COVID, are also known to cause conditions like shingles and cold sores, Walls says. These illnesses “like to reactivate when something else is already bothering you,” he explains. This could be, for example, not getting enough sleep, stress in your personal or professional life, or another illness like COVID.

COVID rashes in children

Children may develop skin rashes due to viral infections, including COVID-19. In fact, children are “a little more susceptible to these skin reactions with viruses than adults,” explains Walls.

“Children who are experiencing these viruses for the first time will be susceptible to becoming infected with these things,” explains Gehlhausen. For example, dermatologists see many children with various forms of hives-like rashes, such as: B. Urticaria multiforme, in addition to a viral infection, he says.

When should you see a doctor for COVID rashes?

“If you have a rash and COVID, it’s definitely worth seeing your primary care doctor and talking to them about it,” says Gehlhausen.

That means if you have one of the more common rashes — like hives or a measles-like rash — they're not necessarily “anything scary or concerning,” he adds. “These are just types of rashes that we know are associated with COVID. So that wouldn’t cause us to deal with the virus any differently.”

And if the course is milder, you may be able to treat it at home with over-the-counter antihistamines or pain relievers.

If your rash is severe, covers a large area of ​​your body, or is particularly painful or itchy, you should definitely see a doctor or dermatologist, says Walls. He may be able to prescribe medications such as topical antihistamines or steroids to help your skin heal.

The other worrying situation is if you generally feel very unwell along with the rash. For example, if you have a severe headache, high fever, difficulty breathing, and a rash appears, Walls recommends contacting a doctor.