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The skin manifestations of the novel coronavirus SARS-CoV-2 were not recognized at the early stages of the pandemic but have received much recent attention in scientific journals and global media outlets. Reported manifestations range from pseudo-chilblains to a morbilliform (measles-like) exanthem, urticaria, vesicular eruptions, a dengue-like petechial rash and ovate scaling macules, and plaques mimicking pityriasis rosea.
The New 'Great Mimicker'
Much like with HIV and syphilis, COVID-associated "rashes" seem to be as numerous as they are hard to pin down. The largest published study to date is a nationwide case series in Spain with 375 cases which identified five clinical patterns. Because of the scarcity and low sensitivity of diagnostic tests available, the investigators accepted patients with confirmed disease as well as those with a clinical diagnosis of COVID in the study. Just under half (41%) of patients with pseudo-chilblains had confirmed infection with positive viral cultures and/or serology.
Observed COVID-associated skin patterns were:
Acral erythema with vesicles or pustules; so-called "pseudo-chilblains" (19%)
Vesicular (chicken pox-like) eruptions (9%)
Maculopapular eruptions (47%)
Urticaria (19%)
Livedo or necrosis (6%)
[Editor's note: An atlas with images of COVID-related rashes and other skin changes is available in the
