Rashes associated with COVID-19

For children with COVID-19, most children have mild illness or are asymptomatic. The most common symptoms for COVID-19 are respiratory symptoms, ie fever, chills, cough, fatigue, headache, muscle pain, and sore throat. However, in the news there are now reports of possible skin findings associated with COVID-19. Rashes are a common occurrence with other viral infections in general. Reports out of China showed rashes were only noted in 0.2% of patients whereas in Italy it was reported in up to 20%. There is no specific pattern that has been associated with COVID-19 but there are some recent reports of possible associations.


One you may have heard of is “COVID toes”. This is just another manifestation of a rash that just happens to involve the toes. This presentation looks similar to Chilblains (also known as pernio), something usually seen after exposure to the cold. It can cause red, pink or purple spots on toes or the soles of the feet. For most with “COVID toes”, this presentation was associated with low severity of illness.


The other rash patterns being investigated include a flat and raised red rash (maculopapular), hives (urticaria), a lace-like or fishnet pattern (livedo), and blistering rash (vesicular). The flat and raised red rash is a common type of rash seen with viruses. Sometimes these rashes have been described as showing up before other symptoms, a few days into the illness, or later in the course of the infection. There is still limited data on these types of rashes and if they are a manifestation of the illness versus the body’s reaction.


In the news there has been a lot of mention about Kawasaki syndrome and multi-system inflammatory syndrome associated with COVID-19 (MIS-C). These are very rare presentations for COVID-19. It is occurring in older children than what is typical for Kawasaki and may present in a different way than typical Kawasaki syndrome. Kawasaki’s typically presents with persistent fevers (5 or more days), red eyes without discharge, red, cracked lips and/or tongue (strawberry tongue), rash with red swelling of hands or feet (sometimes peeling), swollen neck lymph nodes. If your child has fever (100.4) and at least 2 of the above symptoms and fever please contact us immediately.


If your child has fever, abdominal pain/diarrhea/vomiting, rashes, trouble breathing, has confusion or seems overly sleepy, or your child appears very ill please contact us immediately.

For more information about MIS-C check out: https://www.healthychildren.org/English/health-issues/conditions/chest-lungs/Pages/covid_inflammatory_condition.aspx



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