Over the past year, I’ve heard rumblings of the “covid skin rash” – characterised by irritated, newly sensitive and overly reactive skin; it’s a phenomenon I’ve discussed in group chats, on social media and next to the proverbial WFH water cooler. But, as persuasive as multiple accounts of the same symptom can be, it’s not real until the research says it is. 

Now, two years after the pandemic began, the research is beginning to shed some light on why so many of us are experiencing such a change in skin condition during or after a coronavirus infection. So, I asked GP and Faace dermatologist Dr Sonia (Sonakshi Khorana) to set the record straight on what “Covid skin” is, why it happens and what to do when you have experienced a flare-up. 

In some cases, yes. “The virus can cause the so-called ‘cytokine storm’ that can make the skin particularly sensitive to inflammation – this can be very severe. Cytokines are part of our immune system and have an effect on other cells,” says Dr Sonia.

“This cytokine storm can create skin and organ coagulation issues and are responsible for some of the skin changes, such as ‘Covid digits’ (toes and fingers) and skin necrosis – with viral exanthema (a term for general rashes, which occurs with other types of viruses) – another cause of dermatologic changes. “Scientists at Imperial College are looking into whether Covid-19 could be reprogramming our immune system, causing adverse reactions to occur.”
“There have also been several skin issues and rashes associated with Covid infection ranging from urticaria (a hive-type rash), prickly heat, chilblains, viral exanthema (similar to the measles rash), ‘maskne’ and hand dermatitis.”

“Several recent studies suggest the possibility of a skin rash being a clinical presentation of coronavirus disease,” says Dr Sonia. “Researchers carried out a survey of 12,000 people and this showed that 17% of respondents testing positive for coronavirus reported a rash as the first symptom of the disease. 

“Although Covid-19 is most often thought of as a disease that affects the respiratory system, rashes have been reported all over the world. Many viral infections can affect the skin, so it’s not surprising that we see these rashes with Covid-19, too. This can also happen with other viral respiratory infections like measles. Occasionally antibiotics can cause skin rashes, as well.”

Due to the novelty of coronavirus, and by novelty we mean “newness” because it’s been anything but fun, doctors and researchers are still learning about the disease. Saying this, it’s not uncommon for viral infections to affect the skin. 

“We have all been experiencing heightened levels of stress and anxiety during the pandemic. Stress can cause a number of skin reactions including worsening acne, eczema, psoriasis, hives, cold sores and hair thinning. Having coronavirus can irritate the skin further due to the increased levels of stress your body is under.”

Remember, self-diagnosis without medical training is nigh on impossible, so be cautious about confirming a coronavirus infection based on skin symptoms. Rashes and other skin lesions are difficult to differentiate without expertise. 

Prickly heat

“This can last for weeks after the infection settles,” says Dr Sonia. “If troublesome, treat with moisturisers (emollients – non-fragranced with gentle ingredients – ceramides, glycerin and oatmeal. Topical steroid creams can help (but shouldn’t be used long-term). Calamine lotion can also be helpful.

Hives

“Antihistamine tablets from a chemist can help with the itch. If the rash affects the face, causing swelling of the lips or tongue, then advice from NHS 111 should be sought. If the swelling is causing breathing problems, then urgent advice is needed. 

“Use emollients – non-fragranced – ceramides, glycerin and keep your creams in the fridge for a cooling effect.”

Mask related skin irritation

Remember, says Dr Sonia, wearing masks can cause oil, make-up, bacteria and dirt to become occluded on the skin. She suggests:

• To gently cleanse the skin twice a day but don’t over-cleanse She recommends the Dirty Faace cleanser which contains glycerin or the La Roche Posay Toleraine cleanser
• Pick the fabric of your mask wisely and remember to wash it regularly
• The Period Faace mask has great ingredients for oil control and helps maintain hydration
• Barrier supporting ingredients such as gluconolactone, panthenol, ceramides, glycerin and niacinamide will boost hydration and encourage healing of the skin
• Use a pimple patch if you have a spot brewing
• Do not over-exfoliate your skin
• Avoid wearing makeup underneath
• Look for non-comedogenic labelling

While the majority of skin rashes that occur alongside coronavirus calm down of their own accord, some do require urgent medical attention. Always seek advice from your doctor if you are unsure.

Main image: Getty