COVID Mouth Rash (Enanthem) Joins COVID-19 Symptoms

COVID Mouth Rash (Enanthem) Joins COVID-19 Symptoms

While rashes on the skin have long been tied to COVID-19, doctors in Spain report that rashes on the inside of the mouth are also occurring in some cases.

The rashes are clinically known as enanthem, and it’s not surprising that they are showing up with COVID-19, said a U.S. dermatologist unconnected to the new study.

“An enanthem is a rash [small spots] on the mucous membranes,” explained Dr. Michele Green, who practices at Lenox Hill Hospital in New York City. “It is very common in patients with viral infections like chickenpox and hand, foot and mouth disease. It is characteristic of many viral rashes to affect mucous membranes.”

The new Spanish study was published July 15 in JAMA Dermatology. Researchers led by Dr. Juan Jimenez-Cauhe, of University Hospital Ramon y Cajal in Madrid, examined 21 patients diagnosed in early April with COVID-19 and associated skin rashes.

The result of this study revealed that out of 21 patients with COVID-19 and skin rash, 6 patients (29%) had enanthem. The age range of these patients was between 40 and 69 years, and 4 of the 6 (66%) were women. The morphology of the skin rash was papulovesicular, purpuric periflexural, and erythema multiforme–like in 1, 2, and 3 patients, respectively. The clinical and histologic findings of the erythema multiforme–like exanthem have been reported elsewhere. No enanthem was observed in patients with urticarial or typical maculopapular rashes. The enanthem was macular in 1 patient, petechial in 2 patients, and macular with petechiae in 3 patients, and was located in the palate in all patients. No patient presented with an erythemato-vesicular enanthem. The mean (range) time between the onset of COVID-19 symptoms and the appearance of mucocutaneous lesions was 12.3 days (range, −2 to 24 days). Interestingly, this latency was shorter in patients with petechial enanthem compared with those with a macular lesion with petechiae appearance. Drug intake and laboratory findings were not associated with any enanthem.

COVID Mouth Rash (Enanthem) Joins COVID-19 Symptoms

COVID Mouth Rash (Enanthem) Joins COVID-19 Symptoms -

This patient presented with coalescing purpuric macules distributed in a periflexural pattern, mainly around the buttocks and inguinal area (A), and enanthem on hard and soft palate consisting of millimetric petechiae without erythema (B).

The mouth rash appeared anywhere from two days before the onset of other COVID symptoms to 24 days after, with an average time of about 12 days after onset of symptoms.

In most cases, the enanthem did not appear to be tied to any medicines the patients were taking, further strengthening the notion that it was illness with the new coronavirus causing the reddish spots to appear.

Just how widespread this symptom is with COVID-19 is still unknown, since “owing to safety concerns, many patients with suspected or confirmed COVID-19 do not have their oral cavity examined,” Jimenez-Cauhe’s group noted.

COVID Mouth Rash (Enanthem) Joins COVID-19 Symptoms

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