The common symptoms of COVID-19 are familiar to most people—many having experienced them more than once—and can include fever, cough, runny nose, loss of taste or smell, fatigue, and other flulike affections.
Less commonly known are the skin changes that may occur both before and after the infection sets in. According to Massachusetts General Hospital, skin symptoms may be the only or first sign that someone has contracted COVID-19.
In a study by the American Academy of Dermatology, more than half of the patients with pernio-like lesions and COVID-19 were otherwise asymptomatic. A woman in her fifties, who spoke anonymously to The Epoch Times, said an itchy red rash on her chest was her only COVID-19 symptom and neither she nor her dermatologist related it to the virus until she tested positive.
Such skin eruptions can resemble prickly heat and chickenpox rashes or present as hives and red, scaly rashes. A registry created by Massachusetts General Hospital, Harvard Medical School, along with the American Academy of Dermatology and International League of Dermatologic Societies, found the most common skin effect was a measles-like rash called morbilliform.
Doctors and scientists are still learning about COVID-related dermatological effects but say they come in many forms—some harmless and others consequential. For example, a skin condition called retiform purpura can be linked to blood clots and be life-threatening in those who are critically ill according to researchers at Massachusetts General Hospital. COVID-19 has been reported to reactivate the varicella-zoster virus, which causes chickenpox and shingles. “Both of these viruses are in the herpes family, persist indefinitely in the body after infection, and can start to multiply again after a period of quiescence,” wrote researchers in Nature.
Long COVID-19 and Long Haulers
Skin reactions associated with COVID-19 may appear after the infection and manifest as symptoms of long COVID-19, which affects up to half of those who originally get the virus. “Many long-haulers are reporting dermatological problems including hives, lesions, and red, scaly rashes,” reported Business Insider. “Sometimes, these issues appear in conjunction with early symptoms; in other cases, it can take weeks or months for skin problems to manifest after a person is diagnosed.”
Seven weeks after testing negative for COVID-19, the woman who spoke to The Epoch Times says she is still experiencing intermittent hives and rashes, a phenomenon reported in medical literature.
Recognition of long COVID-19 skin conditions is growing in the pandemic’s aftermath as symptoms are starting to emerge in those who had the virus. “Studies showed that the most common sequelae were those linked to the lungs, followed by skin, cutaneous, and psychiatric alterations,” found researchers in the Journal Healthcare (Basel) in 2022.
Early and Later COVID-19 Skin Effects
COVID-19’s ability to cause some skin effects such as “COVID toes” and “COVID arm” was seen early in the pandemic. Toes that adopt a bright red or purplish color, blister, itch, hurt or swell were described by the American Academy of Dermatology early in the pandemic adding that fingers can also be affected. The Academy also noted, early in the pandemic, the existence of “COVID arm” or “COVID vaccine arm”—a large rash that appears at the vaccine injection site.
“Rashes that appear more than four hours after getting the COVID-19 vaccine are not a sign of a severe allergic reaction,” the Academy wrote, and are no reason to skip your COVID-19 vaccine.”
Conversely, awareness of the existence of dermatological conditions that appear weeks, months, and even years after a COVID-19 infection is only now emerging. According to the U.S. Centers for Disease Control and Prevention, people who had severe COVID-19 or overall body inflammation (multisystem inflammatory syndrome) with the virus, those who have underlying health problems, or are unvaccinated are the most likely to have lasting effects.
Where does vaccination fit into the picture when it comes to COVID-19 skin effects? A study by the British Journal of Dermatology found that “there was no difference in skin-related symptoms between infected vaccinated and unvaccinated users,” except that “burning rashes, which were less common after vaccination.” A clear connection between receipt of a COVID-19 vaccine and the development of shingles has been established but the disease itself can also activate shingles and therefore is also seen in the unvaccinated according to medical research.
What Causes COVID-19 Skin Effects?
The jury is still out on the cause of COVID-19 skin effects. The most common explanation is that the aggressive immune response to the virus causes persistent inflammation. Yet it is also possible “that rashes and lesions could result from tiny blood clots in the skin,” according to Business Insider. “Some research has indicated that COVID-19 is a vascular disease instead of a respiratory one, meaning it can travel through the blood vessels.”
It is also possible that the virus is “transferred to the skin from respiratory sites by the lymphocytic cells” and causes “ballooning degeneration of the keratinocytes,” postulated researchers in the Journal of Family Medicine and Primary Care.
Speculating about the appearance of shingles following COVID-19 infections, the researcher wrote in the journal Cureus that T-cell and CD8 levels were “significantly decreased” in such patients, “indicating a possibility of SARS-CoV-2 directly infecting lymphocytes, which can eventually present in dysfunctional cells due to direct viral effects. These outcomes create optimum habitat for HZ [herpes zoster/shingles] emergence during an active COVID-19 infection but do not explain the emergence of HZ after clinical and functional recovery.”
Scientists at Mount Sinai Hospital and Mount Sinai School of Medicine found that opposing gene expressions create two molecularly distinct subsets of long COVID symptoms in plasma cells and that multiple and independent processes produce vastly different long COVID symptoms.
What Kinds of Treatments for COVID-19 Exist?
According to research published in the journal Viruses, itchy red patches in patients with COVID-19 are a “consequence of inflammatory processes in the skin,” and can be treated with antihistamines and painkillers like Tylenol. Lesions like COVID toe that resemble chilblains may be treated with, “topical corticosteroids alone or in combination with topical antibiotics.”
The researcher wrote in the journal Cureus that they treated a patient with a COVID-19-related morbilliform rash with oral diphenhydramine (an antihistamine) and topical triamcinolone 0.1% cream (a corticosteroid).
One should consult a doctor for concerning rashes, however, for slight itching, the website Altea lists several at-home and natural treatments that can be tried for relief:
- Do not take hot showers and baths.
- Moisturizing care (e.g., aloe vera gel or Polidocanol-based lotion) to be used daily, 1-2 times a day.
- Store care products in the refrigerator.
- Bath with moisturizing additives, max. 15 min. (e.g., St. John’s wort oil, has anti-inflammatory, antibacterial and analgesic effects).
- Dab areas of skin several times a day with a mixture of apple cider vinegar and water (1: 1).
- Do not scratch, better rub or pinch (bacteria under the nails can lead to further infections).
- If the rash worsens, short-term cortisone-based creams will help.
- For advice on which products to use, contact your dermatologist.
“Cromolyn sodium differs from antihistamine medications, which reduce the action of histamines following the release from mast cells,” says StatPearls research published in the U.S. National Library of Medicine. “Unlike corticosteroids that inhibit the late response of antigen-induced asthmatic reactions, cromolyn sodium inhibits immediate and late reactions.”
Conclusion
The state of medical care during the COVID-19 pandemic has been compared to “building a plane while flying it.” Trust in the mainstream medical system waned as it seemed unprepared and unable to offer advice and treatments to effectively address the pandemic.
That’s why knowing the possible skin effects of a COVID-19 infection is valuable as the virus persists and evolves. If you have an unexplained rash or hives, they could be your first—or only—sign that you have contracted the condition and should get tested. If, on the other hand, you already had a COVID-19 infection (or several), lingering skin conditions are more common than is widely known and that knowledge might put you at ease. The Epoch Times will keep you informed as more information on COVID-19-related skin conditions becomes available.
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