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BACKGROUND One of the challenging aspects of SARS-CoV-2 infection is its diverse multi-systemic disease presentation. OBJECTIVES Evaluate the diagnostic value of cutaneous manifestations of SARS-CoV-2 infection and investigate their duration and timing in relation to other COVID-19 symptoms METHODS: We used data from 336,847 UK users of the COVID Symptom Study app to assess the diagnostic value of body rash or an acral rash in SARS-CoV-2 infection, and data from an independent online survey of 11,546 respondents to investigate skin-specific symptoms and collect their photographs. RESULTS Using data from the app, we show significant association between skin rashes and a positive swab test result (OR:1.67, 95% confidence interval:1.41-1.96). Strikingly, among the respondents of the independent online survey, we found that 17% of SARS-CoV-2-positive cases reported skin rashes as the first presentation, and 21% as the only COVID-19 clinical sign. Together with the British Association of Dermatologists, we have compiled a catalogue of images of the most common skin manifestations of COVID-19 from 400 individuals (https://covidskinsigns.com), which we make publicly available to assist clinicians in recognition of this early COVID-19 clinical feature. CONCLUSIONS Skin rashes cluster with other COVID-19 symptoms, are predictive of a positive swab test, and occur in a significant number of cases, either alone or before other classical symptoms. Recognising rashes is important in identifying new and earlier COVID-19 cases.
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