Data from millions of ZOE COVID Symptom Study app contributors has shown that changes to the skin, fingers, toes, mouth and tongue can be symptoms of COVID-19. Here’s how to spot them and what they feel like.

What are skin rashes like in COVID-19?

Some of the less well-known symptoms of COVID-19 include characteristic COVID rashes,  ‘COVID fingers and toes’ as well as other rashes. ‘COVID tongue’ and mouth ulcers are less common but can also be a sign of infection. 

It’s not clear exactly what causes these changes, but it may be related to the immune response to the virus.

COVID-19 rashes are usually itchy and this may lead to poor sleep. Some people with rashes also experience sensitivity to ultraviolet (UV) light, getting red patches on their face after being outside for a short period of time. 

Rashes associated with COVID-19 fall into these categories:

• ‘Prickly heat’ or chickenpox-type rash (erythemato-papular or erythemato-vesicular rash): This is the most commonly reported rash and it appears as small areas of itchy red bumps. It can occur anywhere on the body, usually starting around the elbows or knees as well as the back of the hands and feet. It can sometimes be crusty, weepy or form blisters and does not tend to affect the face. 
  
  
• Hive-type rash (urticaria): This is the second most commonly reported rash and appears suddenly as raised bumps on the skin which come and go quite quickly over hours. It can involve any part of the body, including the face. This rash is extremely itchy and often starts with intense itching in the palms or soles, and can cause swelling of the lips and eyelids. 

There are other, less common, rashes associated with COVID-19 including Pityriasis Rosea-like, light-sensitive rashes affecting the face or neck. Vasculitis rashes, when small blood vessels in the skin become damaged, are also seen in severe cases of COVID-19 that need hospital support. 

You can see more images of COVID rashes here. 

What are ‘COVID fingers’ and ‘COVID toes’?

So-called COVID fingers and toes (chilblains) are the most specific COVID-19 skin change, not many other skin conditions present in this way. Normally, chilblains are only seen in cold weather and in people who have existing problems with the blood supply to their fingers or toes. 

However, chilblains are occurring more frequently and even in warm weather among those who have COVID-19. It appears as reddish and purplish bumps on the fingers or toes but also the palms. 

COVID fingers and toes can affect many digits and are usually sore but not itchy. For example, people find it painful when typing on a keyboard or walking.

You can see images of COVID fingers and toes here. 

What is COVID tongue?

While less common than other COVID rashes, some people are also reporting changes to their mouth and tongue. These include mouth ulcers and their tongue appearing coated or patchy (similar to geographical tongue). 

While called COVID tongue, symptoms can vary a lot between individuals. Other changes include having a dry mouth and fungal infections (such as oral thrush). Some people also report pain or muscle aches when chewing. 

Read more about COVID tongue here.

When does a skin rash happen in COVID-19?‍

There is a lot of variety in when COVID skin rashes appear and how long they last.

For those who get skin symptoms, almost half (47%) of people experience them at the same time as other COVID‐19 symptoms and over a third (35%) afterwards. However, in a significant minority (17%) have skin symptoms appear before any other symptoms. 

In particular, the hive-type rash seems to be an early sign of COVID-19 infection, although it can appear during and after other symptoms as well, and may last a long time. 

In contrast, the prickly heat or chicken pox-type rashes tend to appear much later than other COVID-19 symptoms, sometimes weeks or months after an infection, and can persist for weeks.

COVID fingers and toes also tend to appear later, weeks or months after someone initially becomes infected. They are more common in young people and those who had a mild infection.

COVID rashes can be stubborn and may require prescribed medication. They can last a long time, sometimes up to several months. Some COVID-related rashes come and go in waves, and these are commonly reported in people with long COVID or post-COVID syndrome.

Data from the ZOE COVID Symptom Study shows that rashes reappear after people receive their vaccinations, often coming back within a few days of their jab. 

How common are rashes in COVID-19?

COVID rashes only affect 9% of people at some point in their illness. 

Data from the ZOE COVID Symptom Study shows that a new skin rash was a slightly better predictive symptom of having a positive test for COVID-19 than a fever or cough.

For one in five people with COVID-19, a skin rash is the only symptom they experience (21%). 

Skin rashes are common and can be caused by many different things, so it’s also important to consider the chances of a new skin rash being caused by COVID-19.

When the rates of COVID-19 are very high in the population, with many people infected, then a new unexplained rash is more likely to be COVID-19. But if rates are very low, then a rash is probably due to something else.

What other symptoms of COVID-19 are common alongside a rash?

COVID rashes can occur alongside other COVID symptoms across all age groups. They are also sometimes associated with a loss of smell (anosmia), fever and cough. 

Depending on your age and sex, you should contact your doctor if you have multiple different symptoms of COVID-19 in the first week of being ill.

What should I do if I have a skin rash and think it might be COVID-19?

If you have a new rash or red and swollen toes or fingers, you should:

• Follow the NHS guidelines and self-isolate at home to help protect the people around you and the wider community.
• Download the ZOE COVID Symptom Study app and log your symptoms to be offered a test through the app.
• Also log your health daily in the app, if you’re not already, to help us understand more about how COVID-19 affects people and contribute to life-saving scientific research.
• Check out our tips on looking after yourself if you are sick with COVID-19, monitoring your health at home and staying hydrated.
  

If your rash is very itchy, ask your GP for prescribed medications such as steroid creams to help alleviate the discomfort. 

If you have red and swollen fingers and toes, keep them warm with gloves and socks. You could also massage in steroid cream to help reduce any soreness, which your GP can prescribe. However, most COVID fingers and toes do not need treatment and gradually clear up over several weeks. 

You should get urgent medical help if you have breathing problems, are suddenly confused, or your lips or face are turning blue. 

Stay safe and keep logging.