Review

Common skin signs of COVID-19 in adults: An update

Samantha Polly, MD and Anthony P. Fernandez, MD, PhD
Cleveland Clinic Journal of Medicine March 2022, 89 (3) 161-167; DOI: https://doi.org/10.3949/ccjm.89a.21126

Article Figures & Data

Figures

  • Figure 1
    Figure 1

    Morbilliform rash in COVID-19. A 77-year-old man was hospitalized with COVID-19 and developed bilateral pneumonia and acute hypoxic respiratory failure. Four days after discharge, while continuing to have low-grade fevers, he developed pink papules confluent over the trunk and extremities consistent with a morbilliform eruption.

  • Figure 2
    Figure 2

    Urticarial lesions preceding COVID-19 diagnosis. A 21-year-old woman with no known previous skin problems developed urticarial lesions in various locations, including the thighs (A) and hands (B) several days before testing positive for COVID-19 as part of a routine screening protocol. She subsequently experienced systemic symptoms including palpitations, cough, fatigue, and loss of taste and smell, but was able to be managed on an outpatient basis with supportive care.

  • Figure 3
    Figure 3

    Vesicular eruption in COVID-19. A 52-year-old man developed a vesiculopustular eruption on his trunk during hospitalization for COVID-19 requiring intensive care unit admission and mechanical ventilation for acute respiratory failure due to respiratory distress syndrome. He recovered and was eventually discharged.

  • Figure 4
    Figure 4

    Pseudo-chilblains (“COVID toes”). (A) A 24-year-old woman developed painful erythematous and violaceous macules involving her dorsal toes after testing positive for COVID-19. She had no other symptoms. (B) A young adult man sought care in a telemedicine encounter after developing painful, erythematous papules on his toes. His eventual COVID-19 status is unknown.

  • Figure 5
    Figure 5

    Vaso-occlusive lesions in COVID-19. (A) A 62-year-old man with COVID-19 developed an irregular, mottled, purpuric patch on his knee extending onto his thigh during an extended hospitalization complicated by septic shock and acute respiratory failure requiring mechanical ventilation. He died of his illness 3.5 weeks after admission. (B) A 77-year-old man (also described in Figure 1) developed purpuric patches with central hemorrhagic crusts on the left buttock shortly after hospitalization for COVID-19.

Tables

  • TABLE 1

    Major categories of cutaneous eruptions in COVID-19

    CategoryPresentationOnset ratesSurvival ratesAdditional notes
    Morbilliform Pink-erythematousblanching macules and papules, commonly on trunk and lasting < 1 weekUsually within 2 weeks of COVID-19 symptom onsetHighaMost common cutaneous finding in confirmed COVID-19 cases
    UrticarialTransient, pruritic edematous papules and plaques lasting about 1 weekCan be before COVID-19 symptomsHighaReported association with gastrointestinal symptoms
    VesicularMinimally pruritic vesicular eruption that can be localized or diffuseCan be before COVID-19 symptomsHighaReported association with neurologic symptoms
    Pseudo chilblainsYounger, healthy patients with tender red-purple papules affecting toes more than fingersUsually within 2–4 weeks after COVID-19 symptom onset Recently reported in “long-haulers”HighaAssociation with SARS- CoV-2 infection is debated
    Vaso-occlusiveHospitalized patients with retiform purpura, livedo racemosa, acral necrosis, or sacral ulcersUsually within 2 weeks of COVID-19 symptom onsetLowerbLinked to systemic vascular thrombosis

    • ↵a More than 95%.

    • ↵b About 80%.

    • Based on information in reference 3.

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