- Doctors in Spain think they found a new coronavirus symptom that can easily go undiagnosed even in hospitalized patients.
- A mouth rash, or enanthem, appeared in roughly 30% of a small cohort of confirmed COVID-19 patients who also displayed skin rashes.
- The CDC doesn’t list skin rashes of any kind on its official COVID-19 symptoms, while the WHO says that skin rashes are less common in coronavirus patients.
What makes the novel coronavirus so hard to diagnose without a proper test is the fact that the virus doesn’t cause many unique symptoms. The sudden loss of smell and taste stands out as an odd COVID-19 sign, but all the others are shared between various medical conditions. Fevers, coughs, and diarrhea can have different etiologies, and they’re not indicative of COVID-19 even though that might be the first thing that goes through your mind these days. Add to that the fact that not all COVID-19 patients display the exact same clinical COVID-19 development, with many people experiencing no symptoms or a mild version of the illness, and clinical diagnosis is virtually impossible. That’s why testing is needed and has to be increased so we can find, isolate, and treat patients as fast as possible and prevent them from spreading COVID-19 to others.
With that in mind, doctors in Spain think they’ve found a new coronavirus symptom that everyone has been missing until now. It’s not listed on the CDC or WHO webpages for the novel coronavirus for the time being. And, as you might have guessed, it won’t be enough on its own to help physicians diagnose the illness any faster.
If you’re familiar with “COVID toe,” the skin lesions that can appear in some COVID-19 patients that were discovered months ago, it won’t surprise you to learn the virus can lead to dermatological symptoms. Researchers from Spain have now published a study in JAMA Dermatology detailing enanthem in patients with COVID-19.
The study details previous work from Italy that identified exanthems, or skin rashes that were observed with some COVID-19 patients. Enanthem is a rash-like lesion that appears inside the mouth. The Spanish researchers say that the symptom may have gone unnoticed so far because many patients do not have their oral cavities examined. That’s a result of safety concerns and protocols, not an omission from treating physicians. The mouth is where droplets and aerosols that can spread the coronavirus originate, of course. Patients are advised to wear face masks and oral cavities can go unexamined, especially if there’s no complaint from the patient.
The mouth rash symptom, like other COVID-19 signs, will not appear in all those infected. The researchers from the Hospital Universitario Ramon y Cajal in Madrid found that only six in 21 patients had enanthem. All the patients also featured skin rashes and tested positive for COVID-19. The doctors found different types of mouth rashes that are split into four categories: “petechial, macular, macular with petechiae, or erythematovesicular.”
The doctors found that the appearance of lesions occurred anywhere between two and 24 days after the onset of COVID-19 symptoms and said that drug intake was not associated with the mouth rashes. As with other COVID-19 symptoms, these lesions can have different causes.
As the scientists note, this work is preliminary and more research is required. They say that “the presence of enanthem is a strong clue that suggests a viral etiology rather than a drug reaction, especially when a petechial pattern is observed.” That’s the kind of detail that might be useful to other physicians, including dermatologists seeing patients who might not know they’ve been infected with the novel coronavirus.
The CDC lists several coronavirus symptoms on its pages but does not mention any dermatological signs. The WHO has “rash on skin, or discoloration of fingers or toes” included in the “less common” list of COVID-19 symptoms.