Diagnostic Value of Cutaneous Manifestation of SARS-CoV-2 Infection

A. Visconti; V. Bataille; N. Rossi; J. Kluk; R. Murphy; S. Puig; R. Nambi; R. C. E. Bowyer; B. Murray; A. Bournot; J. Wolf; S. Ourselin; C. J. Steves; T. D. Spector; M. Falchi


The British Journal of Dermatology. 2021;184(5):880-887. 

In This Article

Abstract and Introduction


Background: One of the challenging aspects of SARS-CoV-2 infection is its diverse multisystemic disease presentation.

Objectives: To evaluate the diagnostic value of cutaneous manifestations of SARS-CoV-2 infection and investigate their duration and timing in relation to other COVID-19 symptoms.

Methods: We used data from 336 847 UK users of the COVID Symptom Study app to assess the diagnostic value of body rash or an acral rash in SARS-CoV-2 infection, and data from an independent online survey of 11 544 respondents to investigate skin-specific symptoms and collect their photographs.

Results: Using data from the app, we show significant association between skin rashes and a positive swab test result (odds ratio 1·67, 95% confidence interval 1·42–1·97). Strikingly, among the respondents of the independent online survey, we found that 17% of SARS-CoV-2-positive cases reported skin rashes as the first presentation, and 21% as the only clinical sign of COVID-19. Together with the British Association of Dermatologists, we have compiled a catalogue of images of the most common skin manifestations of COVID-19 from 400 individuals (https://covidskinsigns.com), which we have made publicly available to assist clinicians in recognition of this early clinical feature of COVID-19.

Conclusions: Skin rashes cluster with other COVID-19 symptoms, are predictive of a positive swab test, and occur in a significant number of cases, either alone or before other classical symptoms. Recognizing rashes is important in identifying new and earlier cases of COVID-19.


During the COVID-19 pandemic, it became clear that the SARS-CoV-2 virus, while mainly targeting the lungs, also affected other organs.[1] The first cases of COVID-19 cutaneous manifestation were documented in China, but the prevalence was very low, at 0·2% in 1099 hospital cases.[2] Italy then reported that 20% of patients on a COVID-19 ward (n = 88) had skin clinical signs.[3] Subsequently, other groups[4–10] have described urticarial rashes, vesicular lesions, and less frequent cases of chilblains affecting fingers or toes (acral rash).

Here, using a population approach, we investigated the diagnostic value of body and acral rashes for SARS-CoV-2 infections using data from 336 847 users of the COVID Symptom Study app, and from an independent survey on COVID-19-related cutaneous symptoms in 11 544 respondents, 2 328 of whom also shared photographs of their skin complaints. The study is summarized in Figure 1.

Figure 1.

Study summary. We used data collected through the COVID Symptom Study app to investigate the ability of cutaneous symptoms to identify SARS-CoV-2 infection (Phase 1). An independent online survey was used to collect skin-specific symptoms in order to explore their presentation, duration and timing in relation to other COVID-19 symptoms, and to collect photographs of skin symptoms (Phase 2). Light-coloured rectangles highlight the data used in the analyses; dark-coloured rectangles represent the observations generated by this study; and the rectangles at the bottom summarize the main findings. CI, confidence interval; OR, odds ratio; QC, quality control.