Introduction
A COVID rash is a skin reaction that can occur in some people infected with COVID-19. Although COVID-19 is primarily known as a respiratory infection, the illness can affect multiple parts of the body, including the skin. Dermatologists have reported several different types of skin changes associated with COVID-19, ranging from widespread red patches and itchy hives to swollen or discolored fingers and toes.
A COVID-related rash does not have one specific appearance. It may resemble other common skin conditions, including allergic reactions, viral rashes, heat rash, or other inflammatory disorders. For this reason, seeing a rash does not automatically mean that a person has COVID-19. The American Academy of Dermatology notes that COVID-related rashes can appear in different patterns and that rashes can also have many unrelated causes.
Understanding what a COVID rash can look like, when it may appear, how it is evaluated, and what treatment may help can make it easier to respond appropriately.
What Is a COVID Rash?
A COVID rash refers to a skin eruption associated with infection by SARS-CoV-2, the virus that causes COVID-19.
Skin manifestations can occur during an active infection, around the same time as other symptoms, or occasionally after the respiratory illness has improved. The CDC notes that dermatologic manifestations have been associated with COVID-19 and that their timing in relation to other symptoms can vary.
There is no single rash that can definitively identify COVID-19. Different people may develop different types of skin changes depending on their immune response and other individual factors.
What Does a COVID Rash Look Like?
COVID-associated rashes can have several appearances.
Some may look like:
- Flat red or pink spots
- Slightly raised bumps
- Widespread red patches
- Itchy welts or hives
- Small fluid-filled blisters
- Purple or reddish discoloration
- Net-like or lace-like patterns
- Swollen, red, or purple toes
- Swollen or discolored fingers
The American Academy of Dermatology reports that COVID-related rashes can appear on almost any part of the body and may be itchy or painful depending on the type.
Common Types of COVID Rash
1. Maculopapular Rash
A maculopapular rash consists of flat areas of altered skin color combined with small raised bumps.
This type of eruption can appear as diffuse red or pink areas and may resemble a common viral rash. The trunk and limbs can be affected.
Maculopapular or morbilliform eruptions have been among the most frequently reported cutaneous patterns associated with COVID-19.
2. Hives
Hives, medically called urticaria, appear as raised, swollen areas of skin. They can be pink, red, or similar to the surrounding skin depending on a person’s skin tone.
Hives are often itchy and may appear suddenly. Individual welts can disappear and reappear in different locations.
COVID-19 can be associated with urticarial eruptions, although hives have many other possible causes, including medications, infections, foods, and allergies.
3. COVID Toes
One of the most widely recognized COVID-associated skin findings is commonly called COVID toes.
This involves swelling and discoloration of the toes. The affected areas may become pink, red, purple, or reddish-brown and can sometimes feel itchy, tender, painful, or burning.
COVID toes resemble chilblains, which are inflammatory skin lesions associated with cold exposure. Not every case of swollen or discolored toes is related to COVID-19, so clinical evaluation may be needed.
4. Vesicular Rash
Some people develop small fluid-filled blisters, known as vesicles.
These eruptions can occur on the trunk or other areas of the body. Because many conditions can produce blisters, including chickenpox, shingles, allergic reactions, and certain medications, a blistering rash should not automatically be attributed to COVID-19.
5. Livedo-Like Skin Changes
Some COVID-associated skin findings can produce a net-like or lace-like discoloration called livedo reticularis.
This may result in reddish, purple, or dusky patterns on the skin. Vascular skin findings can have different causes, and some may require medical evaluation.
6. Petechiae and Purpura
Small non-blanching red or purple spots can occur with some infections and other medical conditions. These are sometimes described as petechiae or purpura.
Because these findings can be associated with problems involving blood vessels or clotting, unexplained widespread petechiae or purpura should be evaluated by a healthcare professional.
Can a COVID Rash Be the Only Symptom?
It is possible for a skin reaction to occur before or without prominent respiratory symptoms, although this does not mean every unexplained rash is caused by COVID-19.
The American Academy of Dermatology reports that some people with COVID-related skin reactions have developed the rash as their first or only noticeable sign of infection.
If you develop an unexplained rash together with other symptoms associated with COVID-19, testing may be appropriate depending on your circumstances and current public-health recommendations.
Other Symptoms That May Occur With COVID Rash
A COVID rash may occur alongside typical COVID-19 symptoms.
These can include:
- Fever or chills
- Cough
- Sore throat
- Fatigue
- Headache
- Muscle or body aches
- Runny or stuffy nose
- Shortness of breath
- Nausea
- Vomiting
- Diarrhea
- Changes in taste or smell
The CDC notes that COVID-19 symptoms vary considerably and can range from mild to severe.
A rash alone cannot confirm COVID-19.
When Does a COVID Rash Appear?
The timing of a rash can vary.
Some people develop skin changes during their acute infection, while others may notice them after other symptoms have started. Certain skin manifestations can also occur after the main illness has improved.
The timing depends on the type of eruption and the individual’s immune response. The CDC specifically notes that the relationship between dermatologic manifestations and other COVID-19 symptoms is variable.
How Long Does a COVID Rash Last?
The duration varies according to the type of skin reaction and the individual.
Many COVID-associated skin reactions are temporary and resolve as the infection improves. However, some eruptions can last longer.
The American Academy of Dermatology reports that most COVID-related skin reactions generally resolve within about a month, although uncommon cases of conditions such as COVID toes or hives have lasted considerably longer.
If a rash continues, repeatedly returns, becomes painful, develops blisters, or changes significantly, medical evaluation is appropriate.
What Causes COVID Rash?
The exact mechanisms behind every COVID-associated skin reaction are not fully understood.
Possible mechanisms include the body’s immune response to SARS-CoV-2, inflammation, vascular changes, and other processes associated with infection.
Different rash patterns may reflect different biological pathways. For example, hives are associated with histamine-mediated inflammation, while some vascular-appearing lesions may involve changes affecting small blood vessels.
This variety helps explain why there is no single appearance of a COVID rash.
Is a COVID Rash Contagious?
The rash itself is not generally considered a separate contagious disease.
However, if the rash is associated with an active COVID-19 infection, the person may still be able to transmit SARS-CoV-2 through respiratory and other infectious secretions.
Therefore, the important concern is not touching the rash itself but following appropriate respiratory-virus precautions when someone has a confirmed or suspected COVID-19 infection.
COVID Rash vs. Allergic Reaction
A COVID rash can resemble an allergic reaction, particularly when it appears as hives.
An allergic reaction may occur after exposure to:
- A medication
- Food
- Insect stings
- Cosmetics
- Skincare products
- Latex
- Other allergens
A rash that develops shortly after starting a new medication or product may have an explanation unrelated to COVID-19.
Severe allergic reactions can cause facial, lip, tongue, or throat swelling and difficulty breathing. These symptoms require emergency medical attention.
COVID Rash vs. Heat Rash
Heat rash usually develops when sweat becomes trapped in the skin. It can produce small red bumps or irritation, particularly in hot and humid conditions.
Because heat rash and viral rashes can look similar, appearance alone may not provide a reliable diagnosis.
Context matters, including recent COVID exposure, other symptoms, weather conditions, medications, and the distribution and behavior of the rash.
COVID Rash vs. Shingles
Shingles is caused by reactivation of the varicella-zoster virus.
It often produces a painful, burning, or tingling rash with fluid-filled blisters that usually affects one side of the body.
A blistering or painful rash should be assessed by a healthcare professional, especially if it involves the face or eye.
How Is COVID Rash Diagnosed?
There is no single skin examination that confirms a COVID rash.
A healthcare professional may consider:
- Appearance of the rash
- Location
- Duration
- Itching or pain
- Other symptoms
- Recent COVID exposure
- Medication history
- Recent illnesses
- Existing skin conditions
If COVID-19 is suspected, testing may be recommended.
The diagnosis of COVID-19 itself can involve viral testing, while the skin eruption is assessed clinically.
Can You Treat a COVID Rash at Home?
Treatment depends on the type and severity of the eruption.
For a mild, uncomplicated itchy rash, general measures may include:
- Keeping the skin cool
- Avoiding excessive scratching
- Using gentle, fragrance-free skincare
- Applying a simple moisturizer
- Avoiding newly introduced irritating products
- Using a cool compress for temporary relief
For hives or significant itching, a healthcare professional may recommend an appropriate antihistamine.
Some inflammatory rashes may respond to topical medications, but it is better to identify the type of eruption before applying strong corticosteroids or other prescription treatments.
Treatment for COVID Rash
There is no single treatment that works for every COVID-associated rash.
Treatment is usually directed toward the particular skin manifestation and the underlying COVID-19 infection.
For example, hives may be managed with antihistamines, while certain inflammatory eruptions may require topical treatment. Severe or unusual eruptions may require specialist dermatologic evaluation.
The American Academy of Dermatology notes that treatment depends on the specific skin reaction, with antihistamines sometimes used for hives and other treatments considered according to the clinical presentation.
If you have COVID-19 and are at increased risk of severe illness, contact a healthcare professional promptly because antiviral treatment may be appropriate depending on your medical circumstances and timing of infection.
Should You Scratch a COVID Rash?
It is best to avoid scratching whenever possible.
Scratching can damage the skin barrier, increase irritation, create small wounds, and potentially lead to secondary bacterial infection.
If itching is severe, ask a healthcare professional or pharmacist about appropriate treatments rather than repeatedly scratching the affected area.
Keeping fingernails short and using cool compresses can also help reduce irritation.
Skincare Tips During a COVID Rash
When the skin is irritated, a simple routine is usually preferable.
Use Gentle Cleansing
Choose a mild cleanser and avoid aggressive scrubbing.
Moisturize
A fragrance-free moisturizer can help reduce dryness and support the skin barrier.
Avoid New Products
Temporarily avoid introducing new cosmetics, exfoliating acids, retinoids, or other potentially irritating products until the rash has settled.
Protect Sensitive Skin
If the rash is exposed to sunlight, appropriate sun protection may help prevent additional irritation or discoloration.
Do Not Pick at Lesions
Picking or squeezing skin lesions can increase inflammation and delay healing.
When Should You See a Dermatologist?
Consider seeing a dermatologist if:
- The rash is persistent
- It is spreading rapidly
- It is painful
- It repeatedly returns
- It forms blisters
- It involves the eyes or mouth
- It causes significant swelling
- You are unsure of the diagnosis
- Over-the-counter care is not helping
A dermatologist can distinguish COVID-associated eruptions from other skin conditions that may require different treatment.
When Is a COVID Rash an Emergency?
A rash accompanied by serious symptoms should not be managed at home.
Seek emergency medical care for symptoms such as:
- Difficulty breathing
- Persistent chest pain or pressure
- New confusion
- Inability to wake or remain awake
- Severe swelling of the face, lips, tongue, or throat
- Fainting or severe weakness
- Rapidly worsening illness
The CDC identifies difficulty breathing, persistent chest pain or pressure, new confusion, and inability to wake or stay awake among emergency warning signs of COVID-19.
Can COVID Cause Skin Problems After the Infection?
Yes. Some skin manifestations may occur after the acute infection.
The American Academy of Dermatology notes that a rash can sometimes develop weeks or months after COVID-19 has cleared.
Other post-COVID skin changes have also been reported, including temporary increased hair shedding. If a new skin problem appears after an infection and does not improve, it is worth discussing with a dermatologist rather than automatically assuming that COVID is the cause.
Can Vaccination Cause a Rash?
Skin reactions can also occur after vaccination, although these are distinct from skin manifestations caused by COVID-19 infection.
Some people can experience localized reactions after vaccination, while rare serious allergic reactions can include widespread hives and swelling.
Severe allergic symptoms such as difficulty breathing or swelling of the face and throat require emergency medical attention.
Because timing alone cannot establish causation, persistent or unusual reactions should be assessed medically.
How Can You Reduce the Risk of COVID-19?
Reducing your risk of COVID-19 infection can also reduce the possibility of COVID-associated skin manifestations.
Follow current public-health recommendations, particularly if you are at increased risk for severe disease.
General respiratory-virus precautions may include:
- Staying home when sick
- Avoiding close contact with vulnerable people while infectious
- Improving indoor ventilation
- Practicing good hand hygiene
- Following current vaccination recommendations
- Seeking medical advice promptly when high-risk individuals develop symptoms
Conclusion
A COVID rash is a skin manifestation that can occur with SARS-CoV-2 infection, but it does not have one specific appearance. It may resemble hives, a widespread viral rash, small blisters, or discoloration and swelling of the fingers or toes.
Because many other conditions can cause similar skin changes, a rash alone cannot confirm COVID-19. The timing of the rash, other symptoms, exposure history, medications, and clinical examination all help determine the likely cause.
Most COVID-associated skin reactions are temporary, although some can last longer. Gentle skincare, avoiding irritation, and appropriate treatment for the specific rash can help with comfort. Persistent, painful, unusual, or rapidly worsening rashes should be evaluated by a healthcare professional.
Most importantly, a skin rash should be considered in the context of the person’s overall health. If it occurs with difficulty breathing, chest pain, confusion, severe swelling, or other emergency symptoms, prompt medical attention is necessary.
10 Frequently Asked Questions About COVID Rash
1. What is a COVID rash?
A COVID rash is a skin eruption associated with SARS-CoV-2 infection. It can have several different appearances, including hives, red patches, bumps, blisters, or discolored and swollen toes.
2. What does a COVID rash look like?
There is no single appearance. It may look like hives, a measles-like rash, red or purple patches, small bumps, blisters, or COVID toes.
3. Is a COVID rash itchy?
Some COVID-associated rashes are itchy, particularly hives. Other eruptions may be painful, tender, or cause no noticeable sensation.
4. Can a rash be the first sign of COVID?
Yes. Some people have developed a skin reaction as their first or only noticeable sign of COVID-19, although many other conditions can also cause rashes.
5. How long does a COVID rash last?
The duration varies. Many resolve within several weeks, while some types can persist longer. Persistent or worsening rashes should be evaluated by a healthcare professional.
6. What are COVID toes?
COVID toes are swollen and discolored toes that may become pink, red, purple, or reddish-brown and may itch, burn, or hurt.
7. Can COVID cause hives?
Yes. Urticaria, commonly called hives, has been reported among the skin manifestations associated with COVID-19.
8. How is a COVID rash treated?
Treatment depends on the type of rash. Mild irritation may improve with gentle skincare, while hives may sometimes be treated with antihistamines. A healthcare professional can recommend treatment based on the specific eruption.
9. Should I get tested if I develop an unexplained rash?
If you have a new unexplained rash along with COVID-19 symptoms or a recent exposure, testing may be appropriate. The American Academy of Dermatology recommends considering a COVID test when a person develops a rash or other COVID-related symptoms.
10. When should I seek urgent care for a COVID rash?
Seek urgent medical attention if the rash occurs with difficulty breathing, persistent chest pain, new confusion, inability to stay awake, severe facial or throat swelling, or other serious symptoms.
