Skin lesions to hearing loss: signs of COVID-19 you may not have heard of

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From skin lesions to hearing loss, emerging data increasingly shows us that COVID-19 symptoms can go beyond what you might expect from a common cold or flu.

By Vassilios Vassiliou, Ranu Baral and Vasiliki Tsampasian, University of East Anglia

Well over two years into the pandemic, hundreds of thousands of COVID-19 cases continue to be recorded every day around the world. With the appearance of new variants, the symptoms of COVID-19 have also evolved. Initially, the NHS (National Health Service, UK) considered fever, cough and loss or change in smell or taste as the main symptoms that could indicate COVID-19 infection. Now recently updated NHS guidelines also suggest looking for symptoms, including a sore throat, a stuffy or runny nose and a headache.

But what about some of the more obscure signs and symptoms? From skin lesions to hearing loss, emerging data increasingly shows us that COVID-19 symptoms can go beyond what you might expect from a common cold or flu.

Skin lesions

COVID-related skin conditions are not uncommon. In fact, a British study published in 2021 found that one in five patients had only a rash and no other symptoms. COVID-19 can affect the skin in different ways. Some people may experience a generalized maculopapular rash (flat or raised areas of discolored skin), while others may experience hives (raised areas of itchy skin).

COVID toes, on the other hand, describes red, swollen, or blistered skin lesions on the toes. This symptom is most commonly seen in adolescents or young adults with mild or no symptoms. Most skin lesions related to COVID-19 tend to disappear after a few days, or even weeks in some cases, without requiring specialized treatment. If the skin is very itchy or painful, you can consult a GP or dermatologist, who can recommend a treatment such as a cream.

COVID nails

During an infection, including that of SARS-CoV-2 (the virus that causes COVID-19), our bodies naturally try to express that they are under unusual stress. They can do this in a variety of weird and wonderful ways, including through our fingernails. COVID nails encompass changes such as:

> Beau’s lines: horizontal indentations that occur at the base of the nails or toenails when there is a temporary interruption in nail growth due to physical stress on the body

> Mees’ lines: horizontal white lines that appear on the nails, thought to be caused by abnormal protein production in the nail bed

> A red half-moon pattern that develops at the base of the nails (the mechanism behind this change is unclear).

Data on the number of people who have COVID nails is limited, but it has been estimated that it could represent up to 1-2% of COVID-19 patients. COVID nails tend to appear within days or weeks of COVID-19 infection as the nails grow. Although they can be painful at first, the vast majority tend to return to normal within a few weeks.

Notably, while these changes could be indicative of COVID-19, they can also be caused by different things. For example, Beau’s lines may be secondary to chemotherapy or another infection.

Hair loss

Hair loss is perhaps an underestimated symptom of COVID-19, usually occurring a month or more after acute infection. In a study of nearly 6,000 people who had previously had COVID-19, hair loss was the most common post-COVID symptom, reported by 48% of participants. It was especially prevalent among people with severe COVID and white women.

It is thought to result from the hair feeling the stress in the body, leading to excessive shedding. Indeed, hair loss can also be triggered by other stressful events, such as childbirth. The good news is that over time, hair grows back normally.

Hearing loss and tinnitus

As with other viral infections, such as influenza and measles, COVID-19 has been found to affect inner ear cells, with hearing loss or tinnitus (a constant buzzing sensation in the ear) sometimes following the infection. In a review study that included 560 participants, hearing loss occurred in 3.1% of patients with COVID-19, while tinnitus occurred in 4.5%.

In a study of 30 people who had been diagnosed with COVID-19 and 30 who had not, none with pre-existing hearing problems, researchers found that COVID-19 was associated with ear damage. internal hearing loss. at higher frequencies. While for the vast majority of patients this resolves on its own, cases of permanent deafness related to COVID-19 have been reported.

Why all these symptoms?

We don’t understand exactly what causes these symptoms, but we do know that the biggest role is played by a process called inflammation. Inflammation is our body’s natural defense mechanism against pathogens. SARS-CoV-2 in this case. It involves the production of cytokine proteins which are important in controlling the activity of immune cells.

Excess production of these proteins, as part of the inflammation triggered by COVID-19 infection, can cause sensory deficits, potentially explaining why some people experience hearing loss and tinnitus. It can also disrupt capillary networks, very small blood vessels that supply blood to organs, including the ears, skin and nails.

The symptoms we have described here are not exclusive to COVID-19 infection. That said, if you notice any of these symptoms, it would be appropriate to consider a COVID-19 test, especially if you are in an area where COVID-19 is circulating.

You can also contact your GP, especially if the symptoms get worse or cause you significant discomfort. At the same time, you can rest assured that most of these symptoms are likely to improve over time.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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