The most common symptoms of COVID-19 are fever, dry cough, loss of taste and smell, joint pain, headache, nasal congestion and fatigue. A less common symptom is rashes that appear on the skin in different ways. These were reported so slowly that it was difficult to establish a proper correlation between them.
However, how COVID-19 affects the skin is very important. In the latest study, skin rash was the first symptom in COVID-19 patients with multiple symptoms, while it was found that rash was the only symptom in 21% of patients.
Capturing the effects of COVID-19 on the skin is important for early diagnosis. In fact, these people can be evaluated as asymptomatic because they do not show many symptoms. Early diagnosis will reduce the spread.
Let’s examine the 4 main changes seen in the skin in COVID-19 and their possible causes.
1.Masylar (cold swelling) -like Lesions
These are generally red swelling or swelling that affect the toes and soles and are also known as COVID foot among the people. For 1-2 weeks, the lesions become more discolored and pale and then disappear spontaneously without any treatment.
Especially, these lesions are observed in children and young adults with no or mild symptoms. Here, most of these skin conditions observed on the skin are associated with the virus. Approximately 60% of patients were reported with these lesions in two international reports related to coronavirus.
Despite this, these lesions are considered to be mild and most patients are not tested for COVID-19, essentially 55% are asymptomatic.
Although a rapid increase in these lesions during the pandemic period is associated with COVID-19, a direct relationship has not yet been established. There is also the possibility that these lesions are due to other factors.
It is not clear when these lesions appear. In the study conducted on 26 COVID-related patients, yeast-like lesions were observed in 73% of the patients. In addition, none of these patients had respiratory-related symptoms, and when these lesions appeared, nobody was COVID positive. The explanation for this is that the lesions appear after a long delay. The emergence of lesions may extend up to 30 days after infection.
What causes these lesions is still debated. The likely agent may be type 1 inteferons, ie proteins that regulate antiviral properties in the immune system.
A theory created is as follows; Thanks to the high production of these interferons, the coronavirus may be rapidly cleared from the body. However, high interferon production causes injury to blood vessels and increased inflammation. This may explain why the disease is not seen at all or is mild in these people, the COVID tests are negative, and the skin damage.
Another theory is related to ACE2, the molecule that the coronavirus binds to the cell. ACE2 is located in many cells in the body, one of which is sweat glands, that is, usually in the palms and soles of the feet. Therefore, these areas may be susceptible to virus damage.
Or because blood vessels are damaged due to the immune response due to the virus, this can lead to cell deaths and mini blood clots in the toes.
This term defines the loss of color and flattening of the skin. In the study conducted on 375 patients in Spain, 47% of the patients found this type of COVID-related rash.
These rashes are associated with more severe COVID-19 symptoms and are commonly seen in middle-aged and elderly patients. While these rashes last 7-18 days, they can come out 20 to 36 days after infection.
Overloading of the immune system in the body is shown as the cause. In some patients, hyperinflammation occurs 7-10 days after infection, causing tissue damage and possibly severe illness and death.
These areas, also known as urticaria, cause increasing itching on the skin. In the study conducted on COVID-19 patients in 4 hospitals in China and Italy, 26% of the complaints of hives were found.
Hives are usually one of the symptoms useful in diagnosis, like other symptoms. Generally, it is more common in middle-aged patients with a more severe course. Viral infections trigger hives and these cells are destroyed, causing the immune system to release histamine through a series of reactions in its system.
4. Chickenpox-Like Lesions
In this symptom, there are vesicles that form like water-filled sacs, just like in chickenpox. This skin condition is quite rare compared to others. In the Spanish study, COVID-19-related chickenpox-like lesions were seen only in 9% of patients.
However, this symptom can also be considered a sign of COVID-19 and used in diagnosis. It is seen 14 days after infection in patients who survived mild.
It is thought to be caused by prolonged inflammation due to antibodies attacking the skin. The layers of the skin are damaged, forming sacs of liquid.