New COVID-19 symptom? Mouth rashes could be latest to make list, suggests JAMA study

Fever, cough and shortness of breath are listed as the tell-tale symptoms of COVID-19. However, if there is one thing the world has learnt this year it is that this disease does not only affect the respiratory system but the entire body. COVID-19 affects the heart muscles, can cause blood clots, and result in a loss of taste and smell too. Recently, skin rashes were suggested to be a symptom seen in COVID-19 patients. Now, a study published in the peer-reviewed journal JAMA Dermatology indicates that along with skin rashes, coronavirus patients also get enanthems (mouth rashes). In fact, the presence of enanthems along with skin rashes may actually confirm that the rashes are due to COVID-19. Exanthems and enanthems Enanthem is a term used to define a rash that occurs inside the body, usually on mucous membranes. The spots are a common manifestation of measles where they appear as reddish pinpoint spots inside the oral cavity. On the other hand, exanthems are skin rashes that occur due to an acute infection or due to a drug reaction. COVID-19 patients have already shown various kinds of skin rashes including hives, chickenpox-like vesicles and erythematous rashes (redness of the skin due to an increase in the flow of blood in the capillaries underneath). As per the study, so far, it has been quite difficult to assess the exact reason for the rash and since oral cavity is rarely checked in coronavirus patients, enanthems usually go unnoticed. The new findings  For their study, the researchers examined the oral cavity of 21 confirmed patients of coronavirus disease at a tertiary care hospital who were taking dermatological treatment from 30 March to 8 April, 2020. The enthanthems were divided into four types:

• Petechial: These look like red spots on the skin and occur due to bleeding inside the skin. Petechiae do not lose their red spots when pressed.
• Macular: These are discoloured non-raised spots on the skin that are larger than petechiae.
• Macular with petechial
• Erythematovesicular: Minute red colour dots (blood-filled vesicles) that are raised and feel uneven on palpitation.

Here are some of the findings of the study:

• About six patients (29 percent percent) showed an enanthem along with skin rashes. Four of these patients were women and all of these patients were between the age of 40-69 years. Out of these patients, one patient had a papulovesicular rash (raised blood-filled rashes which are purplish-red in colour), two patients had purpuric periflexural rashes (purple-red rashes on the ribcage on the sides) and three patients had erythema multiforme like rash (reddish or purple coloured rashes with a typical bullseye appearance).
• All the six patients had the enanthem on their palate. The enanthem was macular and petechial in 3 patients, petechial in 2 patients and macular in 1 patient.
• The patients developed the enanthem in a mean time of 12.3 (2 to 24 days) days after the onset of other symptoms of COVID-19. Those with petechial enanthem showed the rash two days before and two days after the onset of COVID-19 symptoms, which was much earlier than the appearance of the other two types of enanthems.
• Patients with hives or maculopapular rashes - flat but raised skin lesions that are reddish in colour- did not show any enanthem at all.

For more information, read our article on Neurological symptoms of COVID-19/ Health articles in Firstpost are written by myUpchar.com, India’s first and biggest resource for verified medical information. At myUpchar, researchers and journalists work with doctors to bring you information on all things health.