17% of U.K. COVID patients had skin rash as first symptom

21% had rash as only sign, recent study finds

Skin rash might join the list of other symptoms associated with COVID-19.

Dr. Alessia Viscont at King’s College London and fellow researchers analyzed data from 336,847 U.K. users of the COVID Symptom Study app to examine the diagnostic value of body rash or an acral rash in SARS-CoV-2 infection.

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They also got data from an independent online survey of 11,544 respondents to examine skin-specific symptoms and collect photographs.

When users signed up on the app, it collected data on sex, age and ethnicity (Asian, Black, Chinese, Middle Eastern, mixed or white); core health risk factors, including height, weight and common disease status (e.g. cancer, diabetes, and heart, kidney and lung disease); the use of medications (e.g. corticosteroids, immunosuppressants and blood pressure medications); and whether the user is a health care worker.

Participants were also asked if they’d had a COVID-19 test, what kind they had and what the result was. Users could update their status daily and record up to 14 symptoms: abdominal pain, chest pain, delirium, diarrhoea, fatigue, fever, headache, hoarse voice, anosmia, persistent cough, shortness of breath, skipped meals, sore throat and unusual muscle pains. Starting in April 2020, two rashes were also added: raised, red, itchy welts on the face or body, or sudden swelling of the face or lips (body rash); and red/purple sores or blisters on the feet or toes (acral rash).

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The researchers found a significant association between skin rashes and a positive swab test result. Among respondents of the online survey, 17% reported skin rashes as the first symptom, and 21% said it was their only clinical sign.

“This study strongly supports the inclusion of skin rashes in the list of suspicious COVID-19 symptoms. Although they are less prevalent than fever, they are more specific and last longer, and can be easily spotted by patients,” the authors wrote. “Increased awareness from the public and health care professionals regarding COVID-19 skin changes will allow more efficient detection of infection and contact tracing.”

The study was published in the British Journal of Dermatology.