Five skin conditions linked to coronavirus by dermatologists

Doctors claim to have identified five skin conditions associated with coronavirus after studying almost 400 patients in Spain.

Research carried out by the Spanish Academy of Dermatology on 375 people aimed to build a picture of how the disease might manifest in skin symptoms.

Spanish dermatologists were asked to help identify patients who had an unexplained skin ‘eruption’ in the last two weeks and who had suspected or confirmed Covid-19.

The conditions discovered included chilblain-like symptoms, outbreaks of small blisters, red bumps and blotchy skin, but researchers are keen to stress that in some cases it was hard to tell if the conditions were directly caused by coronavirus.

As a result, the public is being urged not to try to self-diagnose Covid-19 based on skin symptoms, because rashes and lesions are common and hard to differentiate without medical expertise.

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The research was conducted through questionnaires and photos of skin conditions in order to detect patterns of the virus’s potential effect on the skin.

Spain’s coronavirus outbreak has so far killed almost 24,000 people and the country has endured some of the world’s toughest lockdown measures since March 14, with children banned from going outside for six weeks.

But experts say there are signs the epidemic is now in decline. Tuesday Spain’s daily toll of registered virus deaths was 301, according to its health ministry, compared to a high of 950 in early April.

The number of new infections also fell to 1,308 on Tuesday, its lowest level since Spain declared a state of alarm on March 14.

Prime Minister Pedro Sanchez has announced a four-phase plan to relax restrictions and enter a ‘new normality’ by the end of June.

What are the conditions identified?

Chilblain-like symptoms

Authors of the study, published in the British Journal of Dermatology, found that in 19% of the suspected or confirmed coronavirus cases studied, chilblain-like symptoms were identified.

Described as ‘acral areas of erythema-edema with some vesicles or pustules’, these lesions affect the hands and feet and may resemble the small, itchy swellings of chilblains.

They are small red or purple spots caused by bleeding under the skin and usually asymmetrical in appearance, the study said.

The symptoms were associated with younger patients, lasted for an average of 12.7 days, appeared later in the course of Covid-19 and were associated with less severe cases of the disease.

Vesicular eruptions

In 9% of cases, dermatologists identified ‘vesicular eruptions’, described as outbreaks of small blisters, commonly itchy, that appeared on the trunk of the body.

These could also affect people’s limbs, may be filled with blood, and could become larger or more spread out.

They were associated with middle-aged patients, lasted on average 10.4 days, appeared more commonly before other symptoms and were associated with intermediate severity of the disease.

Urticarial lesions

A third condition, identified in 19% of cases, was named as ‘urticarial lesions’, which consist of pink or white raised areas of skin resembling a nettle rash.

Known as wheals, these are usually itchy and can be spread across the body, including in a few cases on the palms of hands. These lasted an average of 6.8 days.

Researchers said this condition is common and can have many causes, so is not helpful in diagnosing Covid-19 as a symptom on its own.


Among 47% of cases ‘other maculopapules’ were identified – small, flat and raised red bumps.

In some cases these were distributed round hair follicles and had varying degrees of scaling. The study said the appearance was likened to pityriasis rosea, a common skin condition.

Blood spots under the skin might also be present, either as spots or dots or on larger areas, the researchers said.

A maculopapular condition was found to last 8.6 days on average and usually appeared at the same time as other Covid-19 symptoms, and were associated with more severe cases. Itching was very common, the study found.

Researchers said this condition is common and can have many causes, so is not helpful in diagnosing Covid-19 as a symptom on its own.

Livedo or necrosis

A fifth category of conditions – called Livedo or necrosis – was identified by dermatologists in 6% of cases.

Livedo occurs where circulation in the blood vessels of the skin is impaired, causing it to take on a blotchy red or blue appearance with a net-like pattern.

Necrosis describes the premature death of skin tissue.

The study said patients showed different degrees of lesions pointing to ‘occlusive vascular disease’, where a narrowing or blocking of arteries occurs, limiting blood flow to certain areas of the body.

These conditions were associated with older patients with a severe case of Covid-19, although manifestations of the disease in this group were variable, researchers said.

The study authors said it was difficult to know if these conditions were directly caused by Covid-19 or simply indicated complications of the virus.

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