Dermatologist Urges Vigilance for Exanthem as Coronavirus Spreads

As the novel coronavirus spreads across the US and the World Health Organization declares a global pandemic, dermatologists may be able to play a role in diagnosing and combating the disease, says New York City dermatologist Bobby Buka, MD, JD. In fact, the cofounder of The Dermatology Specialists says that skin signs may emerge as a tell-tale sign of some infections.

“The CDC has emphasized the symptoms that are most common for patients. And those remain fever, dry cough, exhaustion,” Dr. Buka says. “Those mild symptoms of an itchy throat may be accompanied with a viral exanthema, and that can be one of our first very visible indicatives of the onset of COVID-19.”

Based on studies and published data, Dr. Buka estimates that about 11 to 15 percent of all Coronaviridae infections have rash as a presenting symptom. The visual appearance of the rash is non-specific, Dr. Buka says. “It's going to look very similar to our other Coronaviridae in that family…We've never seen COVID-19. We've seen lots of other coronaviruses, so we're familiar with the type of exanthem that can present within the dermatology space.” 

While it’s not clear how many patients with COVID-19 infection develop rashes, Dr. Buka says, “if someone comes in with fever and rash in this current environment, certainly we have a very high index of suspicion for COVID-19.”

The incubation period for COVID-19 is two to 14 days. Dr. Buka stresses that current data suggest that approximately 80 percent of affected individuals will have mild symptoms. A dermatologist who suspects COVID-19 infection in a patient should follow guidelines from the CDC and local health officials in terms of reporting and testing. 

"Emergency rooms and urgent care centers here in New York have specific instructions from the CDC on how to manage calls and whether to direct patients to self-isolate. Dermatologists here have the ability to perform COVID testing, using the same VTM tubes we stock for other viral conditions. New York City Public Health Laboratory can now process these tests.”