A new sign of COVID-19: a rash in the mouth

By Angela Betsaida B. Laguipo, BSNJul 21 2020

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has wreaked havoc across the globe, with more than 14.89 million people infected. Coronavirus disease (COVID-19), caused by SARS-CoV-2, has a string of symptoms that include cough, fever, and difficulty of breathing. As the disease evolved, many patients reported the loss of smell and taste as other accompanying symptoms.

Research letter: Enanthem in Patients With COVID-19 and Skin Rash

Now, a new study reveals that the novel coronavirus may also trigger the appearance of a rash inside the mouth. A handful of patients in Spain has manifested rash-like lesions inside their mouths, baffling doctors if these could be included in the list of potential symptoms tied to SARS-CoV-2 infection.

The study, conducted by the researchers at Ramon y Cajal University Hospital in Madrid, describes a potential addition to the list of signs and symptoms exhibited by patients infected with the novel coronavirus. The study is published in the journal JAMA Dermatology.

COVID-19 symptoms

The U.S. Centers for Disease Control and Prevention (CDC) first listed that the signs and symptoms of COVID-19 disease include fever, cough, aches, and difficulty of breathing. Loss of smell, loss of taste, sore throat, and headaches were added to that list later.

In June, the CDC also included other symptoms that were seen in COVID-19 patients, including nausea, diarrhea, and runny nose. However, in April, a separate group of researchers in Spain found lesions on the feet of patients, which were also tied to the novel coronavirus infection.

The study

To arrive at the findings in this new study, the researchers examined 21 consecutive patients that had presented with both a skin rash and COVID-19 at the Ramon y Cajal University Hospital in Madrid between March 30 and April 8.

The team aimed to determine whether the patients developed the enamthem, a term used to describe the lesions on mucous membranes, inside their mouths.

The oral cavities of the patients who had the enamthems were systematically examined and categorized into four groups – petechial, macular, macular with petechiae, or erythematovesicular.

In the studied group, enamthems or skin rash-like lesions inside the mouths were seen in six of 21 patients with COVID-19, who were between the ages of 40 and 69 years old. Of these, four of the six affected patients were females.

The researchers noted in the study that many cases of enamthems were tied to viral infections. These lesions may present with petechia, macules, vesicles, and papules in the mouth. However, the most common ones tied to viral infections are erythemato-vesicular and petechial patterns. Further, these lesions are commonly seen in adults.

The team also reported that these lesions were unlikely to be a drug side effect, but more linked to the infection itself. Also, the team said that due to concerns on the safety of healthcare workers and clinicians, many patients suspected to have the SARS-CoV-2 infection or are known to be infected, do not have their mouths examined. The new symptom is now added to the list of symptoms found in patients today.

“This work describes preliminary observations and is limited by the small number of cases and the absence of a control group. Despite the increasing reports of skin rashes in patients with COVID-19, establishing an etiological diagnosis is challenging. However, 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,” the team concluded in the study.

Global coronavirus toll

As the disease evolves and spreads across the globe, much information about the virus is being revealed and discovered. The virus is still actively spreading, with the global case toll topping 14.89 million. The death toll has now reached a staggering 615,000.

The United States reports the highest number of infections, with 3.89 million confirmed cases, followed by Brazil, whose case toll has doubled in the past weeks, reaching 2.15 million.

India has reported 1.15 million confirmed cases, while Russia has more than 782,000 cases. One of the major concerns of the World Health Organization (WHO) is the spread of the virus in South Africa due to concerns that the high infection rate may take a toll on the nation’s health system. The country has more than 381,000 infections.