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Your skin is your first line defense system.  The barrier between you and your external environment is known to have a slightly acidic pH, host a variety of normal, even protective microbial life, possess waterproofing qualities and protection from environmental exposures, regulate body temperature, and respond to external stimulation.  But did you know that your skin can also share clues about your internal status?  Dermatologists are able to suspect and workup endocrine (hormonal) disorders such as Diabetes, Adrenal Tumors, or thyroid dysfunction. They can also recognize specific warning signs encoded in the skin that signal autoimmune imbalance, certain kinds of cancer, and even a propensity for cardiac disease.
This deductive process is additionally true for viral infections. Covid-19 is not an exception.
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Taiwanese, Italian, and American physicians are finding that this same process of recognition may also help to identify asymptomatic carriers or characterize early onset symptoms of Covid-19.  Thanks to social media and sharing communities such as Whatsapp, a global network of physicians have been able to pool their clinical observations of this widely unpredictable, evolving pandemic.  In other words, through collective communication, doctors in effected countries have been able to share similarities in patient presentations, shedding light on patterns and trends in the virus’s effect on patients as well as treatment.
One such pattern they have been watching is the development of skin changes which they believe correlate to the underlying effects of the virus.
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Prior to diagnosis of Covid-19, a number of patients were misdiagnosed with rashes masquerading as anything from Dengue fever to chicken pox to livedo reticularis,  pinpoint bruising, urticaria, and red rashes. Many patients are young, and asymptomatic, or displaying a milder version of the virus; while some are progressed and hospitalized.  These skin changes can present anywhere on the body, primarily the trunk and thighs.
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In one collection of Italian data, the most common body parts effected appear to be the feet and hands, particularly the digits and soles of the feet.  These areas tended to display a presentation similar to that of something we see called pernio. The lesions usually effect parts of the body furthest away from the heart (decreased circulation) and away from vital organs (decreased warmth/body heat).  One would describe them as painful, sometimes even itchy, and observe them to be anywhere from red to deep purple in color.   Pernio is an inflammatory skin condition which we see typically after exposure to extreme cold.  Cold causes blood vessels to constrict and in effect, limit the supply of blood reaching the destination tissue.  Similar presentations are also seen when blood flow through vessels become occluded or shut off by small embolisms, plaques, or blockages.  This effect supports the body of evidence that Covid-19 does not only attack the lungs and respiratory system, but it’s effects on the hematologic (blood) system is critical to understanding the disease.  It is important to note that the severity of the skin rash and its effects are in no way correlated to the severity of the virus or the age of the patient.
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As citizens of the world, we have a duty to share what we know with and among eachother.  Knowledge is our power.  If you develop an uncharacteristic rash, or a skin change to which you cannot relate a cause, do not panic, but remain vigilant and/or contact your local dermatologist for proper guidance and consideration.  As always, perform regular skin checks on your loved ones, and note any changes, even in children and teenagers in your household.  This is a great practice for disease and skin cancer prevention, as well as “housekeeping” in general.  If you have any questions and you feel a rash may be related to Covid, Dr. Chaplik is always available via telemedicine.  If you are concerned about a growth or potential skin cancer or infection, otherwise, Dr. Chaplik is available on specific days through the week to evaluate your urgent concerns.
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We want to remind our patients that we are here for you, not only for medical needs, but in unity as well. Feel free to listen to more of the conversation on our YouTube Discussion about more skin signs of covid.  We hope that you are staying home, staying safe, and finding your balance to stay happy.