How can I tell if my rash is a "COVID rash"?

How can I tell if my rash is a “COVID rash”?

COVID-19 can cause a variety of skin changes, and while a rash alone doesn’t confirm infection, certain patterns and timing can raise suspicion. Drawing on evidence-based reviews (Daneshgaran et al. 2020) and a large Spanish classification study (Galván-Casas et al. 2020), this guide will help you identify key features of “COVID rashes,” understand when to worry, and know when to seek medical advice.

What kinds of rashes does COVID-19 cause?
Researchers have described five main patterns:

1. Maculopapular (Morbilliform)

   • Flat or slightly raised red spots and bumps
   • Often widespread, resembling measles or drug eruptions
   • May itch moderately
   • Typically appears with or shortly after fever and respiratory symptoms

2. Urticarial (Hives-like)

   • Raised, itchy welts that may move around the body
   • Can appear before, during, or after other COVID symptoms
   • Often intensely itchy and short-lived (hours to days)

3. Vesicular (Blister-like)

   • Small, fluid-filled blisters on red bases
   • Usually on the trunk or limbs
   • May precede other symptoms by a few days or appear early in illness

4. Chilblain-like (“COVID toes”)

   • Red-purple bumps on toes or fingers, sometimes painful or itchy
   • Seen more often in younger patients with mild or no other symptoms
   • Can last for weeks after other symptoms resolve

5. Livedo or Necrosis (Vascular patterns)

   • Mottled, lace-like discoloration (livedo reticularis)
   • Rarely, skin breakdown or small areas of necrosis
   • More common in severely ill or hospitalized patients

Key clues your rash might be COVID-related
No rash pattern is completely specific, but consider COVID-19 if you notice:

• Timing with other COVID symptoms
– Fever, cough, shortness of breath, sore throat, fatigue, or loss of taste/smell
– Rash appears just before, during, or shortly after these symptoms

• Unusual location or pattern
– Chilblain-like lesions on toes/fingers without a history of cold exposure
– Vesicles that aren’t typical of chickenpox (more localized, not in different stages)

• Itching or pain severity
– Urticarial rashes often itch more intensely than typical viral exanthems
– Vesicular and chilblain lesions can be painful or tender

• Duration
– Most COVID rashes last 1–3 weeks, but “COVID toes” can persist longer
– Rapidly spreading rash or one that changes daily fits some COVID patterns

• Associated signs
– Swollen fingers or toes with chilblain-like lesions
– Mild to moderate fever alongside rash

How do you distinguish a COVID rash from other causes?
Many rashes share similar appearances. Here are pointers to help differentiate:

• Drug reactions
– Often start on the trunk and spread rapidly after new medication
– Highly itchy, sometimes accompanied by facial swelling

• Allergic hives
– Typically very itchy, come and go within hours
– Linked to food, medication, or environmental triggers

• Contact dermatitis
– Localized to areas exposed to irritants (jewelry, soaps, plants)
– Usually improves when the irritant is removed

• Viral exanthems (measles, rubella, enteroviruses)
– May have a characteristic progression (e.g., measles starts on the face)
– Often seen in children, less common in adults

• Chilblains from cold exposure
– History of chilling hands/feet in damp or cold weather
– Improves with warmth and protective clothing

What should you do if you suspect a COVID rash?

1. Take note of other symptoms
   • Fever, cough, sore throat, body aches, shortness of breath
   • Loss of smell or taste is a strong COVID clue

2. Use a free, online symptom check for COVID-19
   • If you’re unsure, try a symptom check for COVID-19 to gauge your risk (link: https://ubiehealth.com/diseases/covid-19)

3. Consider testing
   • A positive PCR or rapid antigen test confirms infection
   • Testing is most accurate within the first week of symptoms

4. Isolate until you know your status
   • Stay home, wear a mask around others, and practice good hand hygiene
   • Follow public health guidelines to prevent spread

5. Monitor for warning signs
   Seek urgent care or call emergency services if you develop:
   • Difficulty breathing or shortness of breath
   • Persistent chest pain or pressure
   • New confusion, inability to wake or stay awake
   • Bluish lips or face

When to see a dermatologist or doctor
Even mild rashes can be uncomfortable or alarming. Contact a healthcare provider if:

• Rash is widespread, worsening rapidly, or extremely itchy/painful
• You have a high fever (>38.8 °C or 102 °F) that doesn’t improve with acetaminophen or ibuprofen
• You notice blistering, peeling skin, or signs of infection (pus, red streaks)
• You have risk factors for severe COVID (age over 65, chronic lung disease, diabetes, immunocompromise)

What treatment options exist?
Most COVID-related rashes improve on their own. Symptom relief may include:

• Topical steroids (e.g., 1% hydrocortisone) for itching and inflammation
• Oral antihistamines (e.g., cetirizine, diphenhydramine) to reduce itch
• Cool compresses or oatmeal baths for comfort
• Good skin care: fragrance-free moisturizers and gentle cleansers

If a rash is severe or persistent, a dermatologist may recommend prescription-strength treatments or further evaluation.

When to speak to a doctor about serious or life-threatening signs
Always err on the side of caution. If you or someone you know experiences any of the following, seek immediate medical attention:

• Rapidly spreading rash with fever and general malaise (possible viral hemorrhagic eruption)
• Skin peeling or blistering over large areas (Stevens-Johnson syndrome)
• Signs of blood clots (leg swelling, chest pain, sudden shortness of breath)
• Severe pain, especially in areas of livedo or necrosis

Summary
While a rash alone doesn’t confirm COVID-19, certain patterns—maculopapular, urticarial, vesicular, chilblain-like, or livedo—along with timing and associated symptoms can point toward a “COVID rash.” When in doubt:

• Note other symptoms and timing
• Try a free, online symptom check for COVID-19
• Get tested and isolate until you know the result
• Use simple remedies for itch and discomfort
• Speak to a doctor about any serious or worrying signs

Always consult a healthcare professional if you’re concerned or if your rash is severe. A qualified doctor can provide a definitive diagnosis, rule out other causes, and guide you to the right treatment. If anything feels life-threatening, don’t wait—seek emergency help immediately.