The ZOE Health Study's COVID rash gallery

‍The COVID Symptom Study, ZOE and the British Association of Dermatologists have a website dedicated to sharing images of COVID-19 related skin rashes: www.covidskinsigns.com.

The website includes over 400 images of the different types of related rashes. The most common are a hive-type rash (urticaria), ‘prickly heat’ or chickenpox-type rash (papular or vesicular rash) and COVID fingers and toes rash (chilblain-like). 

The images were collected back in March 2020 via the ZOE Health Study, which was called the COVID Symptom Study app at the time, to help scientists at King’s College London gather information from members of the public about the symptoms of COVID-19.

Early reports of rashes in hospitalised COVID-19 patients emerged from different parts of the world by late spring 2020. As a result, rash as a symptom was added to the app to investigate further. This allowed the team who created the app to gather data about skin symptoms. App users were also invited to anonymously submit images of their rash to the COVID Symptom Study website. A total of 3,195 images were uploaded. A team of senior UK dermatologists reviewed all the images, classifying and curating them according to the different clinical types. Over 400 images were selected and are now available to view here, which has been funded and created by the British Association of Dermatologists.

The research generated by the COVID Symptom Study app at the time, uncovered that 9% of swab-positive COVID-19 app users reported either a body rash or a rash on fingers or toes, suggesting that rashes are a key symptom of COVID. Rashes were twice as common in children as in adults. A new skin rash was a slightly better predictor of having a positive swab test than a fever or cough. According to the data, rashes may appear before, during or after the presence of other COVID symptoms and sometimes many weeks later. Importantly, rashes were the only sign of infection for 21% with a rash and a positive nasal swab.[*] 

This website is accessible to everyone to help doctors and the general public worldwide to identify whether an unusual rash may be a sign of COVID-19. The gallery will be updated as the research and understanding of COVID-19 related skin signs progresses. 

Dr. Tanya Bleiker, president of the British Association of Dermatologists, comments:

“The association between certain rashes and COVID-19 has become increasingly clear, and being able to recognise these is crucial for reducing the spread of the disease. We’re delighted to announce the launch of the COVID-19 skin signs image gallery, with the COVID Symptom Study team. The extensive library will be an invaluable resource for both healthcare professionals and members of the public in helping to identify rashes which may indicate COVID-19 infection, particularly in those who are otherwise asymptomatic.”

Veronique Bataille, a consultant dermatologist, who led the COVID skin research, comments:

“We have created this COVID-19 rash gallery so that clinicians and any interested parties can have access to it and help them identify potential COVID-19 rashes. Our research shows that rashes can be more predictive of COVID-19 than fever and cough, particularly in children. We found that one in six children gets a rash without any other classical symptoms. For most, COVID-19 rashes last for a few weeks and eventually disappear. In some cases, prescribed medication may be needed if the rash is very itchy.”

Tim Spector, a professor of genetic epidemiology at King's College London and lead of the COVID Symptom app, comments: 

“Thanks to our millions of app users we were quickly able to confirm the link between skin rashes and COVID-19 but also the timing of the rashes, their associations with other COVID-19 symptoms, as well as the different types of rashes across different age groups. We are extremely grateful to all app users who provided pictures via the app as without them none of this would have been possible. We have asked the government to add a new skin rash to the official NHS list of signs and symptoms of COVID-19 as it will reduce infections and save lives.”

Dr. Justine Kluk, a consultant dermatologist involved in the research and curating of images for the website, comments: 

“A group of different skin rashes are now recognised as possible indicators of COVID-19 infection and may be the first or only symptom of the disease in some sufferers. Early reporting of these rashes by members of the public and increased awareness and recognition of them by frontline health workers could help us detect more cases and avoid further spread. This new atlas of COVID rashes, the first of its kind, is an important step forward in helping to raise awareness.”