Does the skin rash seen in some COVID-19 patients tell us about how infection occurs?

Bottom Line:

The skin rash seen in a patient with COVID-19 has similar features to skin rashes caused by other viral infections such as parvovirus B19 or pityriasis rosea, and may be produced by a similar pathway. 

Reference:

Diaz-Guimaraens, B. et al. Petechial Skin Rash Associated with Severe Acute Respiratory Syndrome Coronavirus 2 Infection. JAMA Dermatology (2020).  DOI: 10.1001/jamadermatol.2020.1741

Date Published:

30 April 2020

Synopsis:

This report describes a specific skin rash named “petechial rash” seen in a patient with COVID-19, similar to a rash developed by another virus named parvovirus B19. Skin biopsies from patients with parvovirus B19 are characterized by signs of inflammation and presence of viral proteins within the blood vessels. The authors suggest that the SARS-CoV-2 virus that causes the COVID-19 disease can affect the skin in a similar fashion to parvovirus B19. Analysis of skin samples from patients with COVID-19 who present with a rash demonstrated similarities to another skin condition that is also related to viral infection, named pityriasis rosea. Importantly, while some reports consider this rash to potentially originate from drug reaction, in this case the rash was developed before initiating medications such as lopinavir-ritonavir and hydroxychloroquine. 

Summary by: Sheida Naderi-Azad