The classic symptoms of coronavirus are cough, fever and shortness of breath, but doctors are still building an understanding of the less common symptoms and signs that may also occur in people with COVID-19.

Since the outbreak began, there have been various international reports of individual cases or groups of patients with potential skin manifestations of COVID-19. In March, a WhatsApp group of 400 skin specialists in France started to share information.  The first 295 posts included reports such as skin lesions, red rashes, hives or chilblains. However, the reports have not been collected systematically. We do not know for certain how many of these people had proven COVID-19, or conversely how many people with COVID-19 have skin symptoms.

Skin lesions are not currently listed by the World Health Organisation, the US Center for Disease Control or the NHS as symptoms of COVID-19. However, the CDC emphasises that current lists are not inclusive and that people with any concerning symptoms should seek medical attention.

Where did the story come from?

Several newspapers and magazines have reported that rashes, spots or chilblains might be symptoms of COVID-19. The Daily Express reported a letter to the Journal of the European Academy of Dermatology and Venereology, from the French union of dermatologists. They had created a WhatsApp group of 400 dermatologists to share information about COVID-19, such as practice changes and use of telemedicine. Most posts covered skin symptoms that may be associated with the virus.

What is the basis for the claim?

The letter concerned “all 295 cases” submitted to this group since its inception on March 14th up to April 10th. The majority (219) were said to have been reported directly by members, while others were reported indirectly via the administrator or other social media sites. The letter said that 146 cases were reports of chilblains or chilblain-type lesions. These are itchy, swollen areas on the skin that are usually caused by going out in the cold. The other 149 cases included reports of blistering rashes like urticaria (hives) or chickenpox-like lesions.

The letter reported that the WhatsApp group covered posts of skin lesions seen in “suspected or confirmed COVID-19 patients”. However, it does not say whether the 295 cases reported had been tested for COVID-19. Even if they were confirmed cases, we cannot be sure that all skin lesions were a direct effect of the virus.

Neither is it known how frequent skin symptoms may be among all people with coronavirus. Alongside this letter, various other case reports and case series have been published worldwide.  For example, another letter reported that of 130 patients hospitalised with COVID-19 in Rome, two (1.5%) had an itchy blistering rash, while a similar patient was also found in a Barcelona hospital. Therefore, skin symptoms could be quite rare. he French dermatologists speculate that skin lesions might be more common in people with milder infection who do not need hospital treatment. We do not know whether this is the case.

It is also worth noting that skin rashes are very common, so if someone finds a rash this does not automatically mean they have coronavirus.  Case reports such as these can provide an early warning of important diagnostic clues, but claims based on them will need further quantification.

What do trusted sources say?

The World Health Organisation currently advises: “The most common symptoms of COVID-19 are fever, dry cough and tiredness. Some patients may have aches and pains, nasal congestion, sore throat or diarrhoea.” Potential skin symptoms are also not reported by UK government sources or the US Center for Disease Control. However, as above, the CDC advises that people seek medical attention “for any other symptoms that are severe or concerning to you.”

 

Citation

1.     Duong, TA et al. Did Whatsapp® reveal a new cutaneous COVID-19 manifestation? J Eur Acad Dermatol Venereol. 2020 Apr 24. doi: 10.1111/jdv.16534. [Epub ahead of print] https://doi.org/10.1111/jdv.16534 (Accessed 29 April 2019)

Reading list

1.     Q&A on coronaviruses (COVID-19). World Health Organisation.

2.     Centers for Disease Control and Prevention.