An infection with the coronavirus can also show on the skin. This is confirmed by new analyzes. An expert explains which symptoms you should think of Covid-19 for.

In the case of many viral diseases such as measles, rubella or herpes viruses, the skin offers the first diagnostic signs of an infection. Even with Covid-19, at least some of those affected develop skin changes.

Observations on patients from Italy and Spain at the beginning of the pandemic showed that around one in five Covid-19– Patients experience symptoms on the skin, including flaking and reddened areas of skin and blisters on the skin. However, according to new findings, this frequency is no longer tenable, explains Prof. Matthias Schmuth from the Medical University of Innsbruck in a communication from spring 2021.

“After a year it turns out that it was published prematurely that this number is too high and that careful registry studies are required to provide reliable data,” says Schmuth. He is the director of the University Clinic for Dermatology, Venereology and Allergology, which deals with phenomena such as the so-called Covid toes.

Which skin changes are a signal for a corona infection?

According to the expert, there are definitely symptoms on the skin that indicate an infection with SARS-CoV-2 indicate. “A Covid-19 infection can on the one hand cause rashes all over the body and on the other hand lead to signs of bleeding or thrombosis of the skin,” said Schmuth.

For example, a hives could be an early warning sign of a corona infection. Since the immune system is busy fighting the virus, various other infections could occur as a result. Such rashes can occasionally be observed in patients with suspected Covid in the emergency room.

A Hives (Hives) is characterized by a pale to red skin rash that is usually very itchy or burning. This can occur in only a few places, but also on the entire body.

A study published by Spanish doctors in the British Journal of Dermatology in 2020 identified these symptoms on the skin as signs of Covid-19:

  1. Scaly and reddened skin areas: The flaking of the skin was different in the examined patients, and the reddening was also different: in some of those affected it was more punctiform, in others it was spread over a large area over the skin. These symptoms were particularly evident in patients with a severe course of Covid-19. The authors of the study therefore point out that the skin changes in these patients could also be side effects of the drugs they were taking.
  2. Quaddeln: This skin change was often associated with itching. The so-called urticarial lesions formed primarily on the trunk, but in some patients also on the palm of the hand.
  3. Blisters on the skin: These small vesicles filled with blood were mainly found on the trunk, but also on the limbs. They spread over time and were mostly itchy. In the majority of patients, they occurred at the beginning of Covid 19 disease.
  4. Necrosis: This is severe skin damage caused by an insufficient supply of blood to the skin. The damage occurred to the torso, and in some people also to the nose, chin, ears, toes and fingers. Necrosis was mainly developed by older Covid 19 patients with a severe course of the disease.
  5. Pseudo-Frostbeulen: These are swollen areas of the skin, some of which have vesicles or pustules. These occur primarily on the hands or feet. The pattern, referred to by dermatologists as pseudo-chilblains because of its similarity to real chilblains, was mainly observed in younger patients with only mild corona symptoms.

What about the Covid toes

The skin changes described as pseudo chilblains, which are also called Covid toes, are considered controversial. “Since the beginning of the pandemic, young patients have often come to the ambulance with red-violet discolored toes without any tissue destruction (tissue death). A Covid-19 PCR or antigen test is often negative for them, and often also the one Antibody test. Nevertheless, some suspect a connection with Covid-19, “explains Schmuth.

Real chilblains: Some Covid-19 patients develop skin changes that resemble chilblains. (Source: DR P. MARAZZI / SCIENCE PHOTO LIBRARY / imago images)

One hypothesis is that especially young people with a symptom-free corona infection developed the Covid toes as part of an efficient reaction of the immune system against the virus.

“We are currently collecting these cases and are systematically looking at them together with other centers as part of a study. It is important that we do not draw hasty conclusions – as was seen in the initial phase of the pandemic – but provide answers with the help of careful, scientific work find, “says Schmuth. The toe discoloration may have nothing to do with Covid.

How do Covid-associated skin changes occur?

One thing is certain: Covid-19 skin symptoms still raise many questions. The causes of the rashes have not been definitively clarified. Experts have already pointed out the possibility that the symptoms on the skin are not directly caused by Covid-19. It is also possible that some rashes are due to complications of the disease, reactions to drugs, or even other viruses in patients with “co-infections”.

According to Professor Schmuth, however, it is considered certain that the coronavirus uses the so-called ACE-2 receptor as an entry point into the cells. This is also present in skin cells, so that these could also be infected. In this way, the virus could also be detected directly in the skin.

The cause of the observed thrombosis and microbleeding in the High But be another: “These are not direct, but secondary effects of the infection. We also know this from other organs, where a Covid 19 disease can lead to blockages of blood vessels and damage to the vascular walls,” explains Schmuth. This can be seen in the skin, among other things, in the form of dark purple to black discoloration – often with severe courses on the fingertips or toes.

Important NOTE: The information is in no way a substitute for professional advice or treatment by trained and recognized doctors. The contents of t-online cannot and must not be used to independently make diagnoses or start treatments.


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