Can You Really See Coronavirus On The Skin?
With us now spending more time online, hearsay and rumours can whip up a frenzy more quickly than ever. It will likely come as no surprise to you that coronavirus is not immune to the rumour-mill either. Recently, a rumour has begun to swirl surrounding the affects of Covid-19 on our skin after a case that affected a teenage boy. Other viruses do show signs on the skin (known as Exanthem) and the Zika Virus is perhaps one of the most famous, recent examples of this. So, could spots and rashes on our skin be a sign of Coronavirus?
What Is The Coronavirus On Skin Theory?
Firstly, this theory has been brought to our attention via social media and some recent studies. With that in mind, we would advise you take this with a pinch of salt, in fact, read on for a better understanding of this theory since data is limited. However there might be truths, time and research from data will tell.
How The Theory Goes
It would appear this theory is born out of a study on the case of a 13 year old boy in Italy. The boy suddenly began to present foot lesions in early March. These foot lesions are believed to be the result of a condition known as Acute Acro-Ischemia. After 2 days he also began to exhibit fever like symptoms, muscle pain, headaches and intense itching around the foot lesions. After some images began to circulate on Italian social media of acrolocated ischemic lesions on the feet of children suspected with Covid-19, an investigation shone light on the family of this 13 year old boy. Apparently, the patients mother and sister had both presented fever, cough and dyspnea 5 days before the appearance of his foot lesions. This has lead to much discussion, suspicion and perhaps even a correlation between Covid-19 and skin lesions.
The other theory is that the disease can in-cure a “lighter” form of acro-ischemia and cause Chilblains. Many of these patients do not have other symptoms of COVID-19 and as we know a high percentage can have the virus and no symptoms for 5-14 days, hence the recommended quarantine of 14 days for people that have been in high risk places. A Spanish dermatologist has had many recent cases of Chilblains, however not had access to Covid-19 tests to verify if there is a relation.
What is Acro-Ischemia?
Before we dive into whether this theory holds weight lets quickly address Acro-Ischemia. This is fairly straightforward, Ischemia is a condition in which blood flow and therefore oxygen is restricted or reduced in a part of the body. In this case the toes. ‘Acro’ simply means the topmost or highest, hence ‘Acro-Ischemia’ meaning a lack of blood supply to the toes…
What is Chilblains? (Covid toes)
Chilblains can also be called “chill burns” or pernions (Latin perniones) and are bumps on the skin, red-blooded skin changes due to cold exposure that can occur in people with an underlying condition or idiopathic, often in young women. They are usually the stretch sides of the fingers and toes, the heels or the lower legs can be affected too. A history of chilblains suggests a connective tissue disease (such as lupus). Chilblains may appear in patients with Raynaud’s disease. Here you can read more about “Covid toes“.
First Derm case report April 2020 from Germany
Online user dermatology question
I am a 30 year old male I have been having multiple issues in my left foot for for a couple of weeks, especially one of my toes, problems have reoccured over the months/ years but it has never been as bad as this.
Online dermatologist original answer
UPDATE AFTER REVIEW:
Here is an updated answer: chilblains have been found to be one of many unusual symptoms of Corona virus (covid19) and if you are not already quarantined or you are starting to have other symptoms that may be consistent with Corona we would recommend that you get tested. Kind regards.
Thank you for sending your case. Based on the information and images of your foot, this is possibly TINEA PEDIS: Athlete’s foot is a fungal infection between and on toes caused by warm, moist, tight conditions around feet and toes. This can recur over years and be difficult to treat. You can treat this with over-the-counter antifungal preparations with the addition of hydrocortisone. Preventive measures include good feet hygiene, changing socks frequently and keeping the area between the toes dry. If despite using the above measures, your condition does not improve you should see a family doctor or dermatologist for prescription treatment after the Covid pandemic is over. Your dermatologist can prescribe topical and or oral antifungal medications to treat the condition and assess for other possibilities such as chilblains, chilblain lupus and Raynauds. Kind regards.
Does This Theory Hold Weight?
Let us first address the case above since although this theory could have some plausible claims, we’re unlikely to find them in this story. Firstly, the teenage boy and his family had not been tested for Coronavirus. So, we don’t actually know if this person or his family had the virus or he merely had symptoms of another flu. This in itself is quite a flaw.
Not only are we lacking concrete evidence that the boy and his family had coronavirus but also, in the cases that have followed, we have limited data on gender, age and indeed whether the patient has the virus or not. This lack of data does not allow for concrete decisions to be made.
How Has This Theory Gained Traction?
The reason this theory has took hold to some degree, is due to some patterns within Italian hospitals and studies that have started to explore a correlation. The first study demonstrated that 20% of patients (88 tested) with Covid-19 had presented skin manifestation such as:
However, as we can see, this data is very limited and we cannot truly claim there is a correlation based on this data alone. This conclusion is also supported by a Chinese study that states this theory needs to be monitored more closely since some patterns do emerge. The same study also makes clear that more data is needed to truly investigate the hypothesis.
Our Conclusion on Coronavirus And The Skin
Although this can seem like another case of fake news, it is an attempt to find some correlation between the virus and our skin. This is a natural thing for dermatologists and scientists to investigate. If they could find a pattern then this would truly help us understand the virus more quickly. It would, of course, also aid medical professionals in understanding who has the virus and who doesn’t. Even those of us at home would be able to spot the signs of acro-ischemia.
That said, this theory has been vehemently denied in Spanish and Italian articles. Largely due to the limited data available. We would have to agree that there is simply not enough quality data to draw an honest conclusion and we would advise against passing this theory on as certified. There could be a connection, but at this stage we are nowhere near confirming it to be true.
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Specialist doctor from the University Hospital in Gothenburg, alumnus UC Berkeley. My doctoral dissertation is about Digital Health and I have published 5 scientific articles in teledermatology and artificial intelligence.