• "Enanthems" might be a unique indicator of the presence of the disease compared to other symptoms
  • A multiplicity of COVID-19 symptoms hinders any initial diagnosis of this disease
  • The mouth rash symptom won't appear in all those infected

Skin rashes and mouth lesions could become additional symptoms for identifying patients with COVID-19, according to a new study from Spain.

The findings could make it easier for doctors to diagnose the highly-contagious disease, which often exhibits symptoms suggesting influenza, such as fever, cough, and shortness of breath. These symptoms also can have other etiologies apart from the flu.

Researchers from the Hospital Universitario Ramon y Cajal in Madrid, Spain suggest a symptom their study identifies as a unique marker for infection with COVID-19. The study, which builds on previous research from Italy, identifies mouth "enanthems," or a rash (small spots) appearing on the mouth's mucous membranes, as indicative of COVID-19 infection.

Enanthems are not currently included in the Centers for Disease Control and Prevention's guidelines as symptoms of the virus.

Published July 15 in the peer-reviewed journal, JAMA Dermatology, the study said enanthems were observed in six of 21 patients diagnosed with COVID-19 and a skin rash. The patients were between the ages of 40 and 69; four of the six were women.

"This work describes preliminary observations and is limited by the small number of cases and the absence of a control group," the study said.

All six patients had skin rashes and tested positive for COVID-19. Doctors found different types of mouth rashes, which they classified into four categories: petechial, macular, macular with petechiae, or erythematovesicular.

They said the appearance of the enanthems occurred from two and 24 days after the onset of COVID-19 symptoms. They affirm drug intake was not associated with the mouth rashes.

The Spanish researchers said the presence of enanthems might have gone unnoticed because doctors don't examine the oral cavities of most patients presenting with COVID-19. This is a result of safety concerns and protocols, not a deliberate omission.

"Despite the increasing reports of skin rashes in patients with COVID-19, establishing an etiological diagnosis is challenging," the study said. "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."

Like other COVID-19 symptoms, the mouth rash symptom won't appear in all those infected. These lesions can also have different causes.

Graphic on ongoing problems experienced by some people who initially showed mild symptoms of the noval coronavirus
Graphic on ongoing problems experienced by some people who initially showed mild symptoms of the noval coronavirus AFP / John SAEKI