Skin manifestation of COVID 19


  • Idiopathic:

    The exact cause is not known of Skin manifestation in COVID-19.
  • Certain virus causes skin rash:

    It’s common for virus to produced skin rashes. Measles, chickenpox and herpes are examples of viral infections with distinctive rashes - the result of the inflammation caused when the immune system fights the infection within the skin’s cells. On the basis of these viral infections with different skin rashes, COVID-19 could generate a similar skin reaction in some patients.
  • Immune system:

    The inflammatory changes occur in the skin when the immune system fights the infection within the skin’s cells and that can cause the skin manifestation.
  • Changes in blood vessels due to:

    Vascular damage can occur due to COVID-19 such as damage to endothelium due to inflammation of blood vessels and alteration in blood coagulation. These cause the thrombotic changes in blood vessels which lead to acro-ishaemic manifestation on skin.
  • Drug-induced:

    Different drugs which are used in the treatment of COVID-19 can cause mild to severe side effects including different kind of skin rash apart from other systemic side effects.


  • A study in China reported that Skin rashes were present in only 0.2 percent of more than 1,000 COVID-19 patients
  • A smaller study in Italy reported that the prevalence of skin rashes was 20.4 percent.

Study on skin manifestation in COVID-19

375 cases were observed for skin manifestation in this study. Study showed 5 types of skin manifestation which are mentioned below.

  1. A macula-papular rash: (47%)

    Most common rash observed in the study. These rashes covered 47 % of all skin rashes.
  2. A rash on hands and feet that looks like Chilblains (The so-called Covid-19 toes): (19%)
  3. 3A hives-like rash: (19%)
  4. These were observed in 19% of cases. They are consisted of small, slightly elevated reddish or white patches on skin.

  5. A blistery rash: (9%)
  6. It was found in 9 % of the cases. Consisting of tiny, similarly shaped blisters, this rash was found on the abdomen or back of some patients and on the arms or legs of others.

  7. Livedo (also known as necrosis): (6%)
  8. It was found in 6% cases. A sign of poor blood circulation, this rash was characterized by purplish skin with a lace-like pattern.


Type of eruption: Pseudo-chilblain

Age: Younger age

Duration: 12.7 days

Stage of COVID-19: Less severe disease

Area involved: Hands and feet

Survival: 100%

Type of eruption: Vesicular

Age: middle-aged patients

Duration: 10.4 days

Stage of COVID-19: medium severity

Area involved: Trunk and limbs

Survival: 100%

Type of eruption: Urticarial rash

Age: middle-aged patients

Duration: : 6.8

Stage of COVID-19: more severe COVID‐19

Area involved: Trunk and few on palm

Survival: 100%

Type of eruption: Maculopapular

Age: middle-aged patients

Duration: 8.6

Stage of COVID-19: more severe COVID‐19

Area involved: Limbs and dorsum of hand

Survival: 98%

Type of eruption: Livedoid or necrotic lesions

Age: Older age

Duration: 9.4

Stage of COVID-19: more severe COVID‐19

Area involved: Trunk or Acral region

Survival: 90%


  • The researchers have concluded at certain level that some of these eruptions or rashes are actually due to the effect of COVID-19 and can be use as diagnostic for COVID-19, whereas some are not useful for diagnostic purpose due to other cause rather than COVID-19.
  • Pseudo-chilblain and vesicular lesions may be useful as indicators of disease.
  • Urticarial lesions may be due to many causes so they are unlikely to lead to the diagnosis.
  • Maculopapular lesions such as the pseudo vesicular type and those resembling erythema elevatum diutinum or erythema multiforme could lead to suspicion of a diagnosis.
  • Livedoid or necrotic lesions are probably not useful for diagnosis. As they are due to vascular damage due to COVID-19.

NOTE: The more study is needed with help of large number of samples in this area of skin manifestation and COVID-19 to reach a firm conclusion.