Is a nasty red rash another coronavirus symptom to watch out for? How skin changes could help to identify people who should be tested

• There are a growing number of reports of infected Covid-19 patients with rashes
• Doctors also reported chilblains – red patches on toes and fingers – in patients
• More research is needed to determine if skin conditions are linked to the virus
• But if proven, it might be an important development in controlling the disease
• Here’s how to help people impacted by Covid-19

A new, raised red rash and unexplained marks on the skin could be signs of Covid-19, experts have warned. Data from Italy indicates as many as one in five people hospitalised with Covid-19 may develop rashes or experience changes to the skin.

In some cases, a rash could potentially be the first – or only – sign of infection. According to the NHS, the main symptoms of the coronavirus are a new and continuous cough, and a high temperature. 

However, it has been estimated that up to eight out of ten people infected may experience only mild, or show no symptoms of the illness at all. And, as cases rise, multiple additional symptoms have been linked to the virus.

Telltale sign: Some experts believe that a rash could be a side effect of the immune system fighting a coronavirus infection. In fact, it is common for any virus to trigger skin rashes

The World Health Organisation says diarrhoea, a sore throat and aches and pains can indicate infection. In the UK, ear, nose and throat specialists have warned that a loss of smell, know as anosmia, and often taste could be a symptom. 

Now there are a growing number of reports of infected patients who have developed rashes, and experts are keen to establish whether the virus is the cause.

‘I have seen quite a few patients who don’t normally suffer from eczema or allergies who have a sudden, odd rash,’ says Dr Veronique Bataille, an NHS consultant dermatologist. 

‘Then, maybe two or three days later, they have developed typical Covid-19 symptoms. For some patients, we believe a rash may be the only symptom that they get.

Ever wonder why…

…Scars don’t disappear?

Skin is made up of a protein called collagen, produced by cells known as fibroblasts.

When skin or tissue is damaged, new fibroblasts are generated as part of the healing process. They produce scar collagen – which is different from normal collagen and forms in a criss-cross pattern to help strengthen and heal the wound.

Normal skin cells are shed constantly by humans – in fact, we lose an estimated 200 million every hour.

Scars are a separate structure and do not shed in the same way.

However, once healed, blood supply to the wound will reduce and some of the collagen may break down, making them paler and smoother in appearance.

‘The public should look out for this and other possible symptoms in members of their household.’

A study of 88 infected patients at the Lecco Hospital in Lombardy, one of the hardest-hit Italian regions, found 20 per cent experienced changes to their skin. 

None of them had taken drugs that could have caused the reaction. Eight out of the 18 patients who noticed changes to their skin did so at the onset of their symptoms.

Doctors have also reported chilblains – red patches on toes and fingers usually caused by cold temperatures – in some coronavirus patients.

‘The skin is the largest organ in the body – and it’s visible,’ says Professor Hywel Williams, co-director of the centre of evidence-based dermatology at the University of Nottingham. 

‘So if you are very unwell, and your lungs are sick, it’s not surprising really that the skin reacts in some way in about a fifth of cases.’

In fact, it is common for any virus, including the one that causes Covid-19, to trigger skin rashes. But, unusually, the rashes detected in Covid-19 patients seem to vary significantly in appearance. 

Scientists don’t yet fully understand why these rashes occur. But it is thought it could be a side effect of the immune-system trying to bring the infection under control.

More research is needed to determine if the skin conditions are definitely linked to Covid-19 (file photo of person taking their temperature with a thermometer)

Dalia Dawoud, 46, from North London, first noticed a red rash on her body five days after her husband, 51, began showing Covid-19 symptoms. The rash resembled chicken pox but with smaller, less itchy pimples.

Her husband, an A&E consultant in the NHS, had already tested positive for the virus, and her daughters, aged 11 and 17, were also showing symptoms, so her illness did not come as too much of a surprise.

But the rash, which is not mentioned in NHS Covid-19 guidance, was unexpected.

Weird science: About one in three of us is estimated to have insomnia

But far less common is fatal insomnia – an extremely rare disease which affects the thalamus, the part of the brain that regulates sleep.

The disorder is usually inherited and has been diagnosed in just a few dozen families worldwide.

Early signs include problems sleeping, muscle spasms and stiffness.

But over time the effects of this type of insomnia worsen – almost completely depriving sufferers of any rest. As a result, they will experience terrifying hallucinations and a loss of co-ordination, and their mental function will completely deteriorate.

There is no treatment and without sleep, which is vital for survival, they will die within just a few months or years.

Dalia, a scientific adviser, says: ‘I didn’t have any of the flu-like symptoms. This rash was the first thing to appear.’

After a few days, Dalia developed a mild cough and fever, which quickly passed. But her rash persisted for about a week, and she suffered on and off with fatigue and headaches for a fortnight.

More research is needed to determine if the skin conditions are definitely linked to Covid-19. 

The American Academy of Dermatology, which represents thousands of dermatologists, is already gathering data from doctors around the world. 

If a link is proven, it might be an important development in controlling the disease, as experts believe rashes could help to identify people who may be infected and should be tested for the virus.

Dr Jeremy Rossman, honorary senior lecturer in virology at the University of Kent, says: ‘The fever might not start until later in the disease in some patients, and others might have a rash, or gastrointestinal symptoms earlier on.’

But Dr Bataille stresses that a rash is not necessarily something to be concerned about, especially if a patient has reacted in a similar way in the past.

Any new rash should in adults or in children should be discussed with a GP promptly.

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