Dermatologists warn red spots, blisters and itchy wheals could be a sign of the killer coronavirus 

Red spots on the hands, blisters on the torso and itchy wheals have been identified as possible signs of the coronavirus.

Dermatologists have warned of five skin symptoms that may be a sign of the deadly infection after studying 375 patients in Spain.

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

The most common skin symptom was a rash made of small red marks, either flat or raised. In some cases, they were scaly. 

Chilblain-like lesions on the hands and feet were seen in mostly young patients, and itchy wheals were present in more severe cases. 

Some patients had small itchy blisters, sometimes filled with blood, on their trunk, according to the results.

While a blotchy red pattern linked to an impairment in blood circulation was most commonly seen in the elderly.  

SARS-CoV-2 tends to cause a cough and a fever, but as the pandemic has worn on, research has linked all sorts of bizarre health problems. 

But the British Association of Dermatologists is urging the public not to try to self-diagnose COVID-19 based on skin symptoms.

It warned that rashes and lesions are common for various diseases and are hard to differentiate without medical expertise. 

‘Urticarial lesions’, or wheals, were also identified in a fifth (19 per cent) of cases. These consist of pink or white raised areas of skin resembling a nettle rash (stock photo)

In nine per cent of cases, dermatologists identified outbreaks of small blisters, commonly itchy, that appeared on the trunk of the body (stock photo)

In nine per cent of cases, dermatologists identified outbreaks of small blisters, commonly itchy, that appeared on the trunk of the body (stock photo)

Livedo or necrosis, was identified by dermatologists in six per cent of cases. Livedo occurs where circulation in the blood vessels of the skin is impaired (stock photo)

Livedo or necrosis, was identified by dermatologists in six per cent of cases. Livedo occurs where circulation in the blood vessels of the skin is impaired (stock photo)

One skin complaint was more common in children and are similar to chilblains (pictured, stock)

One skin complaint was more common in children and are similar to chilblains (pictured, stock)

The latest research, published in the British Journal of Dermatology, aimed to build a picture of how the disease might manifest in skin symptoms. 

Suspected cases were included because medics wanted to look at how the skin was affected at different stages of the disease.

However, they were unable to include a large number of people who were critically ill due to consent issues.  

Patients were asked about their symptoms and had photos taken of their skin to find patterns of the virus’s potential effect. But no photos were published in the paper. 

WHAT ARE THE FIVE SKIN CONDITIONS LINKED WITH CORONAVIRUS? 

1. Other maculopapules

Identified in 47 per cent of cases, the rash consists of small, flat or raised red bumps. It lasts eight days on average.

The average age or disease severity was not described for this condition. 

2. ‘Acral areas of erythema-edema with some vesicles or pustules’

These small red or purple spots caused by bleeding under the skin were seen in around 19 per cent of patients.

They affect the hands and feet and resemble itchy swelling of chilblains. 

They were seen mostly in young patients, lasted around 13 days, appeared later in the course of disease in less severe cases. 

3. Urticarial lesions

Also known as wheals, these lesions these consist of pink or white raised areas of skin resembling a nettle rash.

They lasted an average of seven days and found in more severe cases of COVID-19.  

4. Vesicular eruptions

These occurred in nine per cent of cases. They were described as outbreaks of small blisters, commonly itchy, that mostly appeared on the trunk of the body but sometimes the limbs. 

Middle-aged patients reported the blisters the most. The symptom lasted on average ten days, and were linked with intermediate severity of the disease.  

5. Livedo or necrosis 

This was identified by dermatologists in six per cent of cases, mostly the elderly who were severely ill.

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.  

The most common skin condition was ‘other maculopapules’, identified in 47 per cent of the cases. 

The rash consists of small, flat or raised red bumps. In some cases these were distributed round hair follicles and had varying degrees of scaling. It lasted for eight days on average.  

The study found that 19 per cent of its cases had ‘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 symptom was associated with younger patients, lasted for an average of 13 days, and appeared later in the course of disease in less severe cases. 

‘Urticarial lesions’ were also identified in a fifth (19 per cent) of cases. These consist of pink or white raised areas of skin resembling a nettle rash.

Known simply as wheals, these are usually itchy and can be spread across the body, including in a few cases on the palms of hands.

Urticarial lesions were found to last an average of seven days, and usually appeared at the same time as other COVID-19 symptoms.

Those with more severe COVID-19 cases reported urticarial lesions. 

In nine per cent 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 ten days, appeared more commonly before other symptoms and were linked with intermediate severity of the disease.  

A fifth category of conditions, livedo or necrosis, was identified by dermatologists in six per cent 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.

Livedo and necrotic lesions are relatively uncommon but the study authors said it was difficult to know if they were directly caused by Covid-19, or simply indicated complications.

Researchers noted that maculopapules and urticarial lesions are common and can have many causes, meaning they may not be a helpful aide for diagnosing Covid-19. 

In some cases, it was hard to tell if skin conditions were directly caused by the coronavirus or indicated a complication. 

The British Association of Dermatologists is urging the public 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. 

Commenting on the findings, Dr Faheem Latheef, a consultant dermatologist and skin allergy specialist, said normally skin symptoms are caused by the body’s immune system, not the virus itself.

‘The main reason is a hypersensitive immune reaction,’ he told MailOnline. ‘It’s the body’s reaction to something it perceives as foreign.

‘But ones such as livedo, that’s due to clotting in the vessels. So it’s a mixture.’ 

Dr Latheef has been drafted in to help on coronavirus wards at Leeds City Hospital. He said he had not seen any COVID-19 patients with skin abnormalities.

Studies are mostly coming from Italy and Spain, where dermatologists were still operating their clinics while the virus spread.

‘We were slightly more prepared and so we cancelled a lot of our clinic appointments and are doing them remotely. GPs similarly aren’t seeing things their end.

‘So there is potentially more people walking around with skin complaints we haven’t seen.’

Dr Adil Sheraz, a consultant dermatologist and British Skin Foundation spokesperson said: ‘A variety of skin manifestations have been seen in COVID-19 positive patients. 

‘However we are uncertain whether these are directly related to the virus itself or to the complications of the infection.

‘If you develop a new rash then please speak to your GP or dermatologist. Almost all dermatologists are offering virtual consultations and even face to face in urgent cases. A diagnosis of COVID-19 should not be made from just the presence of a rash.’

WHAT ARE THE COMMON AND ‘ATYPICAL’ SYMPTOMS OF COVID-19? 

The NHS website states that the symptoms of COVID-19 are:

  • A high temperature
  • A new, continuous cough

The World Health Organisation says other indicators include fatigue, aches and pains, a blocked nose, sore throat and diarrhoea. 

As the coronavirus infects millions globally, anecdotal and scientific studies have spotted some other ‘atypical’ symptoms:

Headaches and dizziness

A study in China found that 13 per cent of 214 patients hospitalised with COVID-19 had headaches, and 17 per cent reported dizziness. Overall more than a third reported neurological symptoms. 

The team explained the symptoms may be due to the way in which the virus attaches to cells in the body – through ACE2 receptors found in human organs and tissues within the nervous system. 

Loss of taste and smell

Data gathered by ENT UK, which represents ear, nose and throat specialists, suggests an inability to smell — and often taste — may be the very first symptom and can start within hours.

Those with the symptom are thought to be mostly healthy young adults whose immune systems react sufficiently to the virus to contain it within the nose, preventing it spreading to the lungs, where it can cause potentially fatal pneumonia.

Testicular pain

In February, scientists in China claimed the virus could attack the male reproductive organs – but there is not enough robust research to prove it.

The virus binds to the ACE2 receptors on cells which are found in abundance in the testes, and could lead to ’tissue damage’, the team speculated in their paper, which has not been peer-reviewed.

A 42-year-old man from America tested positive for the coronavirus after going to hospital with testicular pain, even though there were no signs of abnormalities.

Skin changes

Dermatologists in Spain warned of five skin conditions that may be symptoms of the killer infection after studying 375 patients. Their paper was published in the British Journal of Dermatology

The most common was a rash made of small red marks, either flat or raised, affecting almost half of patients. Sometimes they were scaly. 

Following behind chilblain-like lesions on the hands and feet, seen in mostly young patients, and itchy wheals which are seen in more severe cases. Both affected a fifth of patients. 

Small itchy blisters, sometimes filled with blood, appeared on the trunk of some patients, while a blotchy red pattern linked to an impairment in blood circulation was most commonly seen in the elderly.  

A study of 88 coronavirus patients at Alessandro Manzoni Hospital in Lecco, northern Italy, found one in five complained of skin manifestations.

They had not taken any medications or drugs in the preceding 15 days, which could have caused a skin reaction. 

‘Numerous cases’ of chickenpox-like marks on the feet have been reported in Spain, Italy and France, mostly in children.  

The phenomenon is not well researched. But one theory is that skin eruptions are caused by the closure of tiny blood vessels, which might be induced by the nervous system in response to the virus.