Fever, tiredness, dry cough and shortness of breath are common symptoms of the new coronavirus called COVID-19, but not everyone who develops the disease has the same symptoms. Some people may get a runny nose, sore throat or diarrhea or lose their sense of smell. Doctors are also seeing skin rashes on the body and purple spots on the feet, toes and (less commonly) the hands in some patients diagnosed with coronavirus. (These spots are being dubbed “COVID toes.”) In some cases, the coronavirus skin rash or spots may be the first or even the only symptom of COVID-19.
“There have been an increasing number of reports of skin rashes and other skin manifestations, and this is something we’re watching very closely,“ said Ted Schiff, MD, founder and chief medical officer of Water’s Edge Dermatology.
Photo credit: International Federation of Podiatrists
Virus-induced rashes, like the coronavirus skin rash, are not uncommon. They can happen as a result of the immune system’s attempt to fight the invader. With COVID-19, doctors in several countries have reported seeing various types of skin changes, including:
| Exanthems, especially on the torso: widespread, patchy red rashes |
 Photo credit: CDC/Dr. Heinz F. Eichenwald via Wikimedia Commons |
| Urticaria (hives): red or skin-colored bumps that appear suddenly |
 Photo credit: SecretName101 via Wikimedia Commons |
| Purpura Petechiae: clusters of small round spots that may look like a rash and that result from broken blood vessels |
 Photo credit: User:Hektor via Wikimedia Commons |
| Livedo reticularis: mottled skin, often on the legs, caused by obstructed small blood vessels near the skin |
 Photo credit: Nantsupawat T et al via Wikimedia Commons |
| Foot and toe lesions: purple spots (aka “COVID toes”), similar to chilblains (lesions caused by blood-vessel narrowing upon exposure to cold air), that may be painful |
 Photo credit: International Federation of Podiatrists |
The purple spots appearing on toes, feet and sometimes hands, which may resemble a bruise, are thought to result from blockages or tiny clots in small blood vessels. For reasons not yet understood, the coronavirus rash appears to occur more often in children and adolescents with COVID-19 than in adults. Some doctors are reporting cases thought to be associated with COVID-19 in which the spots cover the entire tip of the toe. At least one case of scabbing has been reported. The spots heal on their own and don’t appear to dangerous.
Since children infected with SARS-CoV-2, the virus that causes COVID-19, often have no other symptoms of the disease — even though they can pass the virus on to others — purple spots can be helpful as possible signs of infection.
People with unusual skin changes should contact their healthcare provider. A virtual visit with a board-certified dermatologist, primary care physician or pediatrician is likely the best option in non-emergency cases. When a skin change is the primary symptom or the only symptom, a dermatologist may be best equipped to provide an accurate diagnosis.
If the doctor suspects COVID-19, he or she will recommend self-quarantine for 14 days and can help you determine if testing is needed and available.
Article Written By: Marianne Wait, an award-winning health and wellness writer based in New Jersey.
Medical Review By: Ted Schiff, MD
