01/05/2020
Skin Conditions in Covid infected person.
Dear All, An unprecedented pandemic Covid 19 has gripped the humans across the globe, killing many without a prejudice for the country of stay, citizen, gender, caste, religion, etc. It has given a new norm to mankind in keeping distance & hand hygiene. As a Skin Specialist, I feel my duty to research the Virus Covid 19 affecting the most visible organ – SKIN. Here I have tried to give an overview of the skin conditions reported from across the globe in patients with all ethnicity and age groups. I hope this is useful.
1. Chilblain Like Symptoms – This is reported in 20% of patients presenting with Covid 19 infection. The patient develops painful pus-filled or water-filled bullae as if the hot water has been splashed on the fingers & toes. There is redness and swelling on each such bullae. This is similar to the swelling some people develop when they are exposed to severe cold weather in many parts of the World, including India.
The patient may report itching along with pain & swelling in and around the red areas which are not in a perfect shape rather appears in bizarre shapes.
Another feature found was that these disappear on an average in 13 days.
The reason for development has been linked to micro bleeding underneath the skin layers.
Age Group Link- Younger age group.
Severity Link- The best part so far found is that these developments in patients who have milder Covid 19 infection.
2. Vesicular ( water filled ) Eruptions- In about 10% of cases reported globally, patients presented to Dermatologists with itchy very small bullae or vesicles that are filled with clear fluid. There was an outbreak of blisters mainly on the trunk & limbs i.e. on the chest, back, arms & legs. It was confused with the development of chickenpox when a patient presents to a family physician, as there is a history of fever& sore throat along with these blisters. Positive Covid 19 status and many patients having few blisters filled with blood like fluid make it different from another viral infection - chickenpox.
Age Group link- These were found more in middle-aged patients and tends to heal on its own in 10 days.
Severity Link -These are linked with the intermediate severity of Covid 19.
3. Wheals – Common itchy round raised white to pink lesions with itching has been reported in 20% of patients with Covid 19.
These look like common nettle rash or chapaki and may appear before any other symptom related to Covid 19.
These clear on taking antihistamines or allergy medicines and in 7 days disappear completely.
Many patients reported itching on palms & soles too.
4. Pityriasis Rosea like lesions – Red with itching small rounded bumps appearing around the hair on various parts of the body is perhaps the most common finding where close to 50% patients present with these lesions.
Scaling or peeling of the skin has been reported.
Blood spots are also discovered on a closer look & examination.
Severity Link- These appear in patients with severe Covid 19 infection
5. Livedo – A new feature has been reported in hospitals treating Covid 19 cases in Japan, Korea, Singapore, European countries, United States, and also few cases from India, where very small blood vessels mainly arteries and even smaller arterioles get blocked due to platelet cells collection. This hampers the blood circulation farther to the blocked vessel. As these are very small vessels mainly the skin takes the toll and dies leading to painful necrosis. So far about 6% of patients have been found to report this feature. It is present mainly in patients who have Diabetes, Hypertension, or any other chronic ailments.
The skin becomes red, blotchy initially, progressing to blueish hue with pain. There is a development of a net-like pattern as the minute vessels get clogged and the blood in them gives a net-like appearance. Finally, the skin due to lack of fresh blood supply and oxygen dies. This is known as necrosis. The whole process is called Livedo.
Severity Link – Livedo or Necrosis is seen with severe Covid 19 infection and has a poor prognosis or outcome.
