Covid-19 and Skin Problems: A Dermatologist’s Guide

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Covid-19 Infection and Skin Problems

Covid-19 infection is a multi-system disorder where skin involvement is common. Interestingly, data from a UK Covid-19 symptoms study with 11544 respondents reveals that:

  • 17% of Covid-19 positive patients reported skin rashes as the FIRST presentation of symptoms;
  • 21% reported skin rashes as the ONLY clinical problem of Covid-19.

Similarly, Covid skin issues have also been reported in 20.4% of Italian patients, 7.25% in Indians and 0.2% in Chinese.

What Are the Common Skin Problems Caused by Covid-19?

A Spanish study published in April 2020 with 375 cases shows the following as the most common skin problems:

  • Pseudo-chilblain/Covid toes (where the toes are swollen and inflamed)
  • Vesicular (small blisters / bubbles)
  • Urticarial (hives)
  • Maculo-papular (red rash)
  • Livedo necrotic (this is the most severe problem when the blood supply to the skin is compromised)

Our Singapore General Hospital has also published their review and reported similar observation as the above Spanish study.

Skin Problems Related to Personal Protective Equipment (PPE)

What started off in early 2020 as a flu like illness with serious pneumonia risk has gotten dermatologists very busy as well. Skin problems, especially those triggered by Covid-19 PPE measures and mRNA vaccination are what we see most often now.

Facemasks

Dermatologists are seeing increased “mask related facial rash” like:

  • Acne / Maskne
  • Seborrheic eczema
  • Contact dermatitis
  • Atopic eczema
  • Rosacea

These skin rashes could be a brand new problem with no previous history or a flare up of pre-existing problems. The mask-induced occlusion, increase friction and increase moisture led to:

  • Skin barrier damage
  • Changes in bacterial population on the skin
  • Increase in skin hydration and pH level
  • Increase sebum production (both on the covered and uncovered skin) and
  • Skin temperature changes

Hand Washing and Hand Sanitizers

Skin Specialist also see increased number of patients with hand eczema because of the need to use hand sanitizers and to wash hand regularly. During the Covid-19 outbreak in China, 66.1% of healthcare workers washed their hands more than 10 times per day. BUT only 22.1% applied moisturizers after hand washing. Lack of hand care and discipline to use hand moisturizes trigger and aggravate hand eczema.

Skin Problems Related to Covid-19 Vaccination

Covid-19 Vaccine and Common Skin Side Effects

In a Spanish study with 405 cases, skin rash that occurred within 21 days after any dose of Covid-19 vaccine were regarded as a vaccine side effects. These side effects after Covid-19 vaccination vary from local reaction to widespread skin eruption:

  • Covid arm. A delayed large local site reaction with redness, soreness and swelling is the most common. Covid arm is more frequent in mRNA vaccine and in women. It usually resolved in 2-5 days, and it may relapse after the 2nd dose, usually less severe.
  • Rash that looks like active Covid 19 infection e.g., chilblains, hives etc.
  • Flare or initiation of skin disorders e.g., eczema, psoriasis, rosacea, cold sores, and chickenpox infection. Less common reactions like cosmetic filler reactions were also reported.
  • Globally, allergic reaction is rare, occurring in 0.2% after first dose and 0.4% after 2nd dose. Out of 9,209,201 doses of the Pfizer and Moderna mRNA vaccines that have been administered in Singapore (as of 30 September 2021), 12,589 suspected side effect reports (0.14% of administered doses) were received. The most common skin allergic reactions include itchy rash, hives and swelling of eyelids, face and lips and these allergic reactions tend to occur early, soon after or within 1-2 days of vaccine administration.
  • Moderna vaccine causes more skin reaction (61-83%) than Pfizer does (17%). Most Skin reactions are not severe and should not prevent the administration of 2nd or booster dose.

Who Should Visit a Dermatologist Before/After Vaccination?

  • Patients who are concerned whether they are suitable for vaccination if they have pre-existing skin problems. e.g., eczema, psoriasis, drug allergy. The common question is whether the vaccination will worsen their existing skin problems.
  • Patients who develop post-vaccination itchy rashes or aggravation of existing eczema.
  • Patients who request for vaccine allergy test before they proceed with the vaccination. Some patients want to know for certain that they will not develop allergy reaction before they go for the vaccination. They need counseling and reassurance from Skin Specialist.

How Can a Dermatologist Help?

A Dermatologist can do the following:

  • Allay their concerns and anxiety over vaccination with proper medical counselling. I will advise them to proceed with vaccination to minimize the risk of serious infection from Covid-19 / Covid-19 death.
  • Advise them the likelihood of true allergic reaction is very low, and most will do well without any issues.
  • Do not skip vaccination because of anxiety over potential skin related issues. We will deal with the skin problem accordingly when it occurs.
  • Explain to them that a rash does not always equate allergy.
  • Advise them whether they are suitable for vaccination with their existing skin problems.
  • Direct them to appropriate authority for further testing and allergy confirmation if truly needed.

Covid has come and stay, and the latest variant is Omicron. Patients need to deal with their skin problems caused by Covid-19 infection, Covid-19 PPE measures as well as Covid vaccination.

As a Dermatologist, I read up and keep myself as current as possible to attend to my patient’s needs. There are many hearsays online and my duty as a dermatologist is to share with them the medical truth and to alleviate their fears of Covid-19 and the vaccine side effects. I treat my patient’s skin problem, I give relevant medical advice on skin care, hand care and mask care so that my patients are equipped with proper medical knowledge how to live and manage with the side effects and issues brought along with Covid-19 and vaccinations issues. I adhere “to cure sometimes, to relieve often, to comfort always” in this ever evolving and disruptive pandemic era.

Dr. Wong Soon Tee

Consultant Dermatologist
doctor_img

Dr. Wong Soon Tee

Consultant Dermatologist

Care and Professionalism Refined by
Over 20 Years of Dermatology Experience

  • MBBS, Yong Loo Lin School of Medicine, Singapore
  • MRCP. Member of Royal College of Physicians, United Kingdom
  • FAMS, Fellow of Academy of Medicine, Singapore
  • Adjunct Assistant Professor, National University of Singapore
  • Visiting Consultant, University Dermatology Division, National University Hospital
  • Visiting Consultant, Aesthetic Plastic Surgery Centre, National University Hospital

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