Can COVID-19 cause a rash?
Yes, it is possible to develop a skin rash while infected with the SARS-CoV-2 virus or in the weeks and months following the acute phase of the illness. These skin eruptions are considered uncommon. The American Academy of Dermatology notes that while rashes can occur, they do not happen frequently enough to serve as a primary indicator of infection for the general population.
A rash alone cannot confirm a COVID-19 diagnosis. No single skin pattern is specific enough to distinguish COVID-19 from other common conditions. Reported rashes often look identical to ordinary viral eruptions, allergic reactions, hives, or chilblains caused by cold exposure. Because of this significant overlap, a skin change cannot establish the presence of the virus on its own. While a rash may accompany other typical symptoms, or occasionally appear as the first noticeable sign, it remains a nonspecific finding. This article outlines the various patterns reported, explains the uncertainty surrounding certain symptoms, and details when to seek medical evaluation.
What a COVID-related rash may look and feel like
Dermatologists have identified five main categories of skin eruptions associated with COVID-19 in adults. These include morbilliform (measles-like) eruptions, urticaria (hives), vesicular eruptions (small blisters), pseudo-chilblains, and vaso-occlusive lesions. The appearance and sensation of these rashes vary widely depending on the type and the individual.
Morbilliform eruptions typically present as widespread red spots and bumps. They can be itchy or tender and may appear on the trunk, limbs, or face. Urticaria presents as raised, itchy welts that can appear and disappear quickly. Vesicular eruptions involve small fluid-filled blisters, which can be painful and require careful monitoring to prevent infection.
Vaso-occlusive lesions differ significantly from the others. These appear as fixed, livedoid, retiform purpuric, or ischemic-looking changes, often resembling purple or net-like patterns on the skin. They have been reported primarily in hospitalized patients with moderate to severe disease. While observational studies note an association between these lesions and severe illness, this does not mean the lesion predicts an individual's outcome. Distinguish these fixed, potentially ischemic changes from transient hives, which are superficial and temporary.
Itching, soreness, and discoloration are common complaints, but distribution varies. The appearance of these rashes may differ across different skin tones, with purple or dark brown hues being more visible on lighter skin, while deeper reds, purples, or grays may be more prominent on darker skin tones.
COVID-19 Rashes: What They Do and Don't Prove
COVID toes and why the link remains uncertain
The term 'COVID toes' refers to chilblain-like lesions that affect the toes and sometimes the fingers. These lesions typically cause swelling, red-to-purple discoloration, spots, itching, pain, rough raised areas, or blisters. They are distinct from ordinary chilblains, which are a common reaction to exposure to cold, damp conditions.
While COVID toes gained significant attention early in the pandemic, the direct causal link between these lesions and SARS-CoV-2 remains scientifically disputed. Many individuals who developed chilblain-like lesions during the pandemic had negative viral tests and negative antibody tests for COVID-19. This suggests that the lesions were not caused by an active or recent SARS-CoV-2 infection in those cases.
Competing explanations exist. Pandemic-related behavioral changes, such as spending more time indoors in cooler conditions or changes in footwear, may have contributed to the increase in chilblains. Because many affected people lack evidence of recent infection, it is inaccurate to assume that 'COVID toes' proves a current or recent COVID-19 infection. The label describes the appearance of the lesion, not the cause. These lesions should not be used as diagnostic proof of SARS-CoV-2 infection.
When a rash appears and how long it may last
The timing of COVID-associated rashes is highly variable and cannot be used as a diagnostic rule. Some eruptions, particularly urticarial (hives) and vesicular (blistering) types, have sometimes appeared before other symptoms like fever or cough. In other cases, the rash emerges alongside respiratory or systemic symptoms. There is also evidence that skin issues can develop weeks to months after the acute illness has cleared, potentially as part of long-term post-viral symptoms.
Regarding duration, the American Academy of Dermatology reports that many general COVID-associated rashes appear to last between 2 and 12 days. This is a descriptive range, not a guaranteed timeline. Recovery speeds vary significantly by individual and by the type of lesion.
Toe lesions and other chilblain-like eruptions often last substantially longer than standard viral rashes. In some instances, skin symptoms associated with long COVID may persist for weeks or even months. Because the timing and duration are so variable, the presence or absence of a rash at a specific point in time does not confirm or rule out COVID-19.
Other possible causes of a new rash
A new rash is far more likely to be caused by a common, non-COVID condition than by SARS-CoV-2. The American Academy of Dermatology emphasizes that allergic reactions, shingles, heat rash, medications, and other dermatologic conditions can produce eruptions that look identical to those reported with COVID-19.
Many common viral illnesses also cause rashes that resemble morbilliform eruptions. Drug reactions are a frequent cause of widespread rashes, particularly if a person has started new medications during an illness. Heat and sweating can also trigger skin eruptions. Conditions like eczema or hives may flare up due to stress or environmental factors unrelated to infection.
Clinicians interpret a rash by looking at the full clinical picture, including timing, medication history, accompanying symptoms, and physical examination. Relying on the visual appearance of the rash alone is insufficient for diagnosis. Assuming that every new rash is COVID-related can lead to unnecessary anxiety and missed diagnoses of other common conditions that require different management.
What to do if you develop a rash with possible COVID-19
If a new rash develops alongside other possible COVID-19 symptoms-such as fever, cough, shortness of breath, or loss of taste or smell-or if there has been a known exposure, consider getting tested for COVID-19. Testing protocols and infection-control recommendations evolve. You should follow the current local public-health guidance available in your area for testing, isolation, and masking. Do not rely on outdated fixed schedules, as these may no longer reflect current best practices or risk levels.
For mild discomfort from the rash itself, conservative comfort measures may help. Keeping the skin clean and moisturized, avoiding hot water, and wearing loose clothing can reduce irritation. If considering over-the-counter medications for itching or pain, check with a clinician or pharmacist first, especially for children, pregnant individuals, those with chronic illnesses, or those with extensive skin disease.
You should seek clinical assessment if the cause of the rash is unclear, if symptoms persist beyond the expected timeframe for mild viral rashes, or if the rash worsens. Particular attention should be paid if the rash involves painful blisters, open sores, pus, numbness, or spreading discoloration, as these may indicate a secondary infection or a more serious dermatologic condition requiring specific treatment.
Warning signs that need urgent medical care
Certain combinations of skin changes and systemic symptoms require immediate medical attention. For general COVID-19 concerns, difficulty breathing, persistent chest pressure, new confusion, or an inability to wake are emergency symptoms that require calling emergency services.
In children and adolescents, a specific post-viral condition called Multisystem Inflammatory Syndrome in Children (MIS-C) must be considered. MIS-C is rare but serious. It may occur after SARS-CoV-2 infection and presents with persistent fever and a rash. If a child has a fever and rash along with abdominal pain, vomiting, diarrhea, bloodshot eyes, dizziness, confusion, or unusual difficulty staying awake, prompt medical evaluation is necessary. A rash alone does not confirm MIS-C, but the combination with persistent fever and systemic symptoms warrants urgent care.
For all ages, rapidly spreading rashes, extensive blistering, very painful lesions, or non-blanching rashes (those that do not fade when pressed) accompanied by systemic illness like high fever or chills, also require urgent medical assessment to rule out serious bacterial or vascular conditions.