About this website:
During the COVID-19 pandemic, it has become clear that in addition to the main symptoms of fever and cough listed by Public Health England and other health agencies, people with the virus can also develop symptoms on their skin. Several papers have been published that outline the key features of these symptoms, but this is thought to be the first central gallery of COVID-19 skin symptoms.
This website has been funded by the British Association of Dermatologists to show images collected by the COVID Symptom Study App, which was created by ZOE Global Ltd to help increase understanding of the disease. These images are subject to copyright and may not be reproduced without prior consent.
About the images – information provided by ZOE Global Ltd / KCL:
The COVID Symptom Study app was developed by Zoe Global Limited, supported by physicians and scientists at King’s College London and Massachusetts General Hospital, Boston. The app collects, on sign up, data on sex, age, ethnicity, and core health risk factors, including height, weight, and common disease (e.g., cancer, diabetes, heart, kidney, and lung disease) status, the use of a set of medications (e.g., corticosteroids, immunosuppressants, and blood pressure medications), and whether the individual is a healthcare worker. Since May 7th 2020, the app also prompts users to self-report detailed information, which can be done retrospectively, about whether they have ever had a SARS-CoV-2 test, and, for each test, how this was performed (e.g., nose/throat swab, antibody testing), and the test result.
By using the app, users can provide updates on their daily health status by answering the question “How do you feel right now?”. If they feel unwell, the app further collects self-reported presence of 14 COVID-19-related symptoms, namely: abdominal pain, chest pain, delirium, diarrhoea, fatigue, fever, headache, hoarse voice, loss of smell, persistent cough, shortness of breath, skipped meals, sore throat, and unusual muscle pains. 4.2 million users were registered by 31st August 2020.
From April 29th 2020, skin manifestations of the disease were added: raised, red, itchy wheals on the face or body or sudden swelling of the face or lips (body rash), and red/purple sores or blisters on the feet or toes (acral rash). Asking the participants to differentiate between a transient urticarial rash and a fixed erythemato-papular/vesicular rash was problematic, so the body rashes were collected together, and the second skin question only covered the more specific acral rash. Marzano et al also divided the many different types of rashes in two broad categories: inflammatory/exanthematous rashes for the various body rashes, and vasculopathic rashes for the fingers or toes. To analyse the prevalence of skin rashes, we took all reported data from 336,847 UK users of the COVID Symptom Study app who registered between May 7th and June 22nd 2020: 6,403 of those reported the presence of skin signs and symptoms. If we restricted the analyses to 2,021 app users who had confirmed COVID with a nose swab in the same period, 178 users (8.8%) reported skin related changes. See preprint of article.
The app includes residents in the UK from 1 to 90 years who downloaded the app and entered regular data either themselves or via proxy (for elderly relatives or children). We received just under 3000 pictures of suspected COVID rashes via the app during our survey. Although the skin survey specifically requested that individuals from BAME ethnicity also submit pictures, only 173 were received.
The use of the app data has been approved by the King’s College London Research Ethics Committee REMAS ID 18210, review reference LRS-19/20-18210 and all subscribers provided informed consent.
About the COVID-19 skin patterns
Reports first from China and then from Europe have shown that the skin can be affected by the COVID SARS2 virus in up to 20% of cases. This virus triggers a lot of immune reactions so it is no surprise that the skin is involved. The problem is that COVID can cause a wide variety of skin signs and symptoms, hence the delay in recognising that these various skin rashes were linked to the virus. There are, however, several types of skin rashes with COVID which are the most common presentations.
We have divided the photographs on this site into the following main categories:
- Urticarial
- Papular-vesicular
- COVID toes or fingers (digits)
- Pityriasis Rosea pattern
- Eczematous papules on neck and exposed chest
- Viral exanthem
- Purpuric or vasculitic
- Oral and lips
We have also seen rarer patterns which did not fit in any of the categories above, but these are rare so are not covered here. We have also seen a lot facial rashes with involvement of the eyelids and cheeks but, for confidentiality, these images cannot be shared on this site. Patients presenting to their doctors with suspected COVID rash should have a nasal swab. However, for many patients the skin manifestations may present weeks or months after the infection and therefore the PCR will usually be negative. Antibody blood tests can be requested but, unfortunately, they are not helpful if they are negative as many individuals who have had swab confirmed COVID did not develop antibodies later on.
The contact form below is for questions about the project or technical issues, we cannot answer any medical queries or accept new images via the website.
