At this point in the long slog of the pandemic, many people are experiencing the telltale symptoms of a COVID-19 infection: an irregular sore throat, wicked cough, congestion, fever, and complete body exhaustion. But a small subset of people also develop less common symptoms, ones that may look like hexagons from a children’s story: hairy tongues, purple toes, marks growing on their faces.
“Every infectious disease has common and rare manifestations,” said Dr. Mark Mulligan, infectious disease specialist at NYU Langone Health. As we learn more about the coronavirus, he said, we may better understand the underlying causes of these infrequent symptoms — but until then it’s largely a conjecture.
Confounding symptoms have been a component of COVID since the start of the pandemic; loss of taste and smell has become a worrying sign of the disease. COVID also has the potential to disrupt menstrual cycles, a side effect some women have also reported following vaccination.
A study of more than 60,000 people who tested positive for COVID and reported their symptoms found that a small percentage had experienced ringing in the ears, sore eyes, rashes, red marks on the face or lips, hair loss and unusual joint pain. A wider analysis of more than 600,000 people in Britain showed that a fraction of people with COVID also developed purple sores and blisters on their feet and numbness throughout their body, among other illnesses.
Doctors don’t know why only some people develop these unusual symptoms. Genetics could play a role, Mulligan said; the vaccination status could have something to do with this, as an unvaccinated person could have a more serious infection, which could generate a different course of symptoms. Scientists have also found that the coronavirus can enter the bloodstream in a minority of people, he said, meaning it’s possible the virus could enter various organs and cause symptoms beyond the respiratory system.
Antiviral treatments such as Paxlovid can potentially ease symptoms such as a COVID-related rash, possibly because they can reduce the amount of virus in your blood, said Dr Kelly Gebo, an infectious disease specialist at Johns Hopkins Medicine. But it is not known whether these symptoms are directly caused by the virus or by the body’s response to it.
Inflammation could also be a culprit, said Dr. Peter Chin-Hong, an infectious disease specialist at the University of California, San Francisco. If the virus enters the bloodstream and affects multiple parts of the body, immune cells flock to those areas, Chin-Hong said. This means that an ear, for example, which the virus would not usually affect, can become inflamed, not function as well and potentially hurt.
COVID also leaves patients in a debilitated state, he said, which means lingering pathogens around their bodies from previous infections — like herpes or the virus that causes shingles — can spread. reactivate, causing rashes or cold sores as a result of COVID.
A third theory is that the stress that can accompany a COVID infection — quarantine anxiety, loss of income, fear of long-term health implications — can also trigger symptoms such as hair loss and hives, Chin-Hong said.
Each of these symptoms, when associated with COVID, usually resolves within weeks, often without treatment, he added. And there are no set rules for how doctors treat them, Gebo said. “We have definitive guidelines on how to treat shortness of breath,” she said, “but we don’t have definitive guidelines on this.”
Here’s what else we know about the causes and potential treatments for some of these symptoms.
Healthy tongue cells replace each other quickly, Chin-Hong said, but if older cells linger and overlap, they form a dark, thick, fuzzy proliferation, often referred to as a hairy tongue. Even before COVID, doctors were seeing patients with a hairy tongue linked to viral infections, smoking, antibiotic use and poor hygiene, he said, adding, “It’s more common than people think”.
“I know it sounds really scary to people,” he said, but the affliction is usually temporary. Some people may also experience a burning sensation in the mouth. Those with this symptom shouldn’t be “freaked out,” Chin-Hong said. People with hairy tongues can use a tongue scraper or toothbrush to scrape these cells from the tongue, and they can practice good oral hygiene to prevent further buildup.
In rare cases, people with COVID can also develop thrush, otherwise known as oral thrush, which occurs when a fungus infects your mouth. It has been linked to a weakened immune system or the use of antibiotics, Chin-Hong said. Doctors usually diagnose thrush by examining white lesions that may sprout on the cheek, tongue, or mouth. treatment is usually 10 to 14 days of an antifungal medication.
When people develop the pins-and-needles sensation on their skin, it may be because their nerves are inflamed by immune cells as they fight infection, Chin-Hong said. It’s also possible that the virus itself could damage peripheral nerves, such as those that go to the hands and feet, Gebo said; this also happens with shingles infection.
“What we don’t know is what is the direct impact of the virus itself or what is the inflammation,” she said. “These are things we are trying to figure out.”
Researchers from Washington University in St. Louis found that people who tested positive for COVID were about three times more likely to report pain, tingling and numbness in their hands and feet than those who tested negative. .
For many people, that tingling sensation goes away within a few days, Gebo said. If patients are in pain, she added, they should see their doctor, who may recommend taking Tylenol or Motrin.
People with persistent nerve pain, even after recovering from the virus, should see their doctor, said Dr. Marc Sala, co-director of the Northwestern Medicine Comprehensive COVID-19 Center.
It’s well established that viruses can induce rashes, Sala said, and he noted that he’s seen a wide variety of skin conditions in COVID patients. The American Academy of Dermatology Association cites itchy bumps, chickenpox-like blisters, rashes that form lacy patterns on the skin, and raised bumps as potential COVID-related skin conditions. If you develop a rash that persists after recovering from COVID, Sala recommends seeing a dermatologist.
Any type of physical or emotional distress can cause your hair to fall out, said Cleveland Clinic dermatologist Dr. Shilpi Khetarpal. It’s not entirely clear whether COVID infection itself or the stress associated with it leads some people to experience hair loss, she said, adding, “It’s not a healing; it comes back. It just takes time.”
Scientists are still conflicted over the causes of “COVID toe,” the rash and chilblain-like blisters that form on some people’s feet and fingers after infection, causing swelling and swelling. purple toes and fingertips. One theory is that people with COVID may have microvascular clots, which occur in the smallest blood vessels and block blood supply, causing this discoloration, Sala said.
Patients who develop COVID toe usually do so during the acute phase of an infection, he added, and symptoms tend to resolve soon after. The American Academy of Dermatology Association recommends using hydrocortisone cream to treat it.
“We’re still learning about COVID,” Mulligan said. “We don’t understand everything.
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