Rash and COVID Toes

Rashes are abnormal changes in skin color and texture, such as redness and spots. Rashes often reflect inflammation in the body, which has a variety of causes. A virus such as COVID-19 may trigger a rash in some people even after they have recovered. Other causes of rashes include dryness, irritants such as detergent, food allergies, reactions to certain medications, stress, and climate.

Your rash may be itchy, dry, red, scaly, crusted, broken, or blistered. The three most common types of rashes in COVID patients are papular rashes (small bumps), urticaria (itchy red welts), and acral rashes, also called chilblains and “COVID toes” (red and swollen hands and feet). The virus creates rashes by forming blood clots and damaging blood vessel walls. The body’s natural immune response to the coronavirus may also result in a rash. In children with COVID-19, a skin rash may be a sign of multisystem inflammatory syndrome.

Seeing a Doctor for Rash and COVID Toes

A mild rash may go away on its own, so you might not need to see a doctor. In more serious cases, your doctor will determine the cause of your rash by asking you questions about your symptoms and thoroughly examining your skin. This could include a skin biopsy to rule out other conditions that can cause a rash. Your doctor may prescribe an anti-allergic antihistamine, an anti-inflammatory antibiotic, or a corticosteroid (such as hydrocortisone).

A child who has COVID-19 and a rash in combination with a fever lasting more than 24 hours, abdominal pain, vomiting, fatigue, or rapid heartbeat should be taken to a doctor. These symptoms are signs of multisystem inflammatory syndrome, which is rare but can be life threatening. Your doctor may want to perform further testing such as blood tests. If your child is confused, unable to stay awake, has difficulty breathing, or has blue, gray, or pale skin, lips, or nails (depending on skin tone), seek immediate medical attention.

Hair Loss

It is normal to experience temporary hair loss after you recover from COVID-19. Also called telogen effluvium, this condition can be attributed to the bodily and psychological stress that this virus causes. Telogen effluvium occurs when more hair follicles than usual are pushed into the shedding (telogen) phase of the hair cycle at once. You might see hair come out when you shower or groom your hair. Hair loss typically occurs two to three months after COVID and may continue for six to nine months. This condition may also be caused by iron deficiency or thyroid problems.

Seeing a Doctor for Hair Loss

In many cases, hair will naturally grow back on its own as your stress goes away within six to nine months. No treatment is needed, but if the condition bothers you, you may visit your primary care physician once you have recovered from COVID. Your doctor may want to perform additional testing such as blood tests to rule out other conditions that may be contributing to your hair loss, such as thyroid issues or vitamin deficiency. If you experience a skin rash, burning sensation, or itchy scalp, you should see a dermatologist. When you see your hair falling out it might contribute to your stress, so it is important to practice relaxation and stress management strategies. Your excessive hair loss will likely end once your stress levels recover.

COVID Nails

Numerous studies report the emergence of thin white lines along nail beds in individuals who have recovered from COVID-19. Presenting 2-3 weeks after recovery, this condition called COVID nails is a manifestation of Beau’s lines, which often emerge after illnesses with fever. Beau’s lines, or thin white lines that run horizontally across the nail, are generally harmless. They indicate that something caused your nail to temporarily stop growing, which may result in a gap in your nail bed. The medical term for this is onychomadesis and it may be brought on by fever or severe stress that often accompanies COVID, as well as injury or chemotherapy.

Those with PASC may also have red crescent moons on their nails, which could suggest microvascular injury or an inflammatory immune system response.

Seeing a Doctor for COVID Nails

Nails grow out and replace themselves within six months, so it is best to be patient and let the lines go away on their own. If you cannot determine what caused your nails to stop growing, you should see a dermatologist. Once you discover the root cause, your nails should naturally begin to grow again.

Red crescent moons on nails can be indicative of arthritis, lupus, heart disease, alopecia areata, or dermatomyositis. It is important to see a dermatologist if you notice sudden changes in the appearance of your nails, especially if you have other symptoms. Your dermatologist will determine whether your symptoms are harmless or whether they require further medical testing.

Self-Care for Symptoms that Affect Hair, Skin, and Nails

There are some basic steps you can take to help manage your symptoms:

For rash and COVID toes:

• Use a fragrance-free moisturizer
• Avoid excessive sweating and overheating
• Avoid restrictive or irritating fabrics such as spandex and wool

For COVID nails:

• Start taking a multivitamin or zinc supplement
• Apply hand cream nightly
• Soak nails in olive oil or salt water
• Avoid tight-fitting footwear