When the pandemic began, everything about COVID-19 was new and unknown, including the correlation between COVID and the skin. Thanks to a comprehensive COVID-19 dermatology registry, dermatologists now have gathered a great deal of data on skin reactions caused by COVID-19 and its vaccines.

“Early April of 2020, the American Academy of Dermatology and the International League of Dermatologic Societies put together a COVID-19 dermatology registry, which allows dermatologists to better understand the skin reactions that people experience from the COVID-19 virus,” said board-certified dermatologist Esther Ellen Freeman MD, PhD, FAAD, director, global health dermatology, Massachusetts General Hospital, Harvard Medical School, in Boston. “Through this registry, physicians and health care professionals across the world share information about the cases they’re seeing, which assists us in recognizing the common skin reactions caused by COVID-19 and helps us better diagnose and treat our own patients.”

Dr. Freeman notes that dermatologists have found a variety of different skin reactions that are associated with COVID-19. Some reactions are milder, like COVID toes, and others are more severe. People have a large variability in their immune response to the COVID-19 virus, which causes the skin to react differently for each person.

“Data1 from large studies in Europe2 show us that about 10% of patients with COVID-19 will have a skin reaction. Of the patients that do have a rash, about 20% will develop the rash either as their only sign and symptom of COVID-19 or their first sign and symptom of COVID-19,” says Dr. Freeman. “In fact, you’re more likely to develop a skin reaction from COVID-19 itself than you are to develop a serious skin reaction from the COVID vaccine."

The duration and treatment of the skin reaction depends on the type of reaction the person has; however, Dr. Freeman says most reactions usually resolve within a month. There are patients who have had skin reactions, such as COVID toes or hives, which have lasted six-to-12 months after the infection, but those types of cases tend to be uncommon.

Dr. Freeman notes that while the different variants of COVID-19 are associated with different symptoms, it’s too early to tell if the different variants cause different skin reactions.

“The symptoms COVID patients experience with the Omicron variant are different from the symptoms COVID patients experience with the Delta variant. For example, the loss of taste and smell, which is very common in patients with Delta, appears to be less common in patients with Omicron. Similarly, a sore throat, which was not common with Delta, is now actually being noted much more commonly in Omicron,” says Dr. Freeman. “I do expect that we may see some differences in how people’s skin reacts to different variants in the coming months, but we just don’t have enough data yet to know.”

In addition to skin reactions being caused by COVID-19, some people report having reactions from the COVID-19 vaccine. Similarly, to what dermatologists are seeing in how the immune system responds to the virus after having COVID-19, they’re also seeing that people’s immune systems respond differently to the vaccine, which means there’s a spectrum of different skin reactions that can be caused by the vaccine.

One of the most common reactions that people can experience is a delayed local reaction to the vaccine, also known as “COVID arm.” The reaction typically starts about a week after the injection, and involves a discolored, raised area over the injection site which goes away on its own, is not harmful and should not stop people from getting vaccinated again.

According to Dr. Freeman, less than 50% of the people who experience a reaction to their first dose have the same reaction to the second dose. It is rare for people who did not have reactions to the vaccine to develop a reaction to the booster.

“After 10 billion doses of the vaccine given worldwide, there’s a lot of safety data,” says Dr. Freeman. “Vaccines are safe and effective, and we encourage the public to consider getting their vaccines and booster to protect themselves against COVID-19.”

Dermatologists are the experts in the diagnosis and treatment of skin rashes.  If you have a skin reaction to COVID-19, a COVID vaccine or booster, make an appointment to see a board-certified dermatologist.

To find a board-certified dermatologist in your area, visit aad.org/findaderm.