Are COVID Toes A Skin Symptom Of COVID-19?

Infection with COVID-19 can cause dermatological symptoms with varying symptoms.¹ Studies have reported the presence of chilblain like reddish, papular skin lesions.² As the world struggles with the pandemic, COVID-19 presents itself with other symptoms. Red, purple skin lesions mostly seen over hands and toes – being called as ‘COVID toes’. Are COVID toes a skin symptom of COVID-19? Let us understand this in detail.

The novel coronavirus disease began spreading across several countries and was later declared as a pandemic. Most commonly known symptoms of COVID-19 have been cough, fever with breathing difficulty that can turn fatal with severe complications like pneumonia in some cases. While there were discussions regarding other possible symptoms, a concern that needs attention is the dermatological symptoms of COVID-19. What is a COVID toe?

Although a correlation between the severity of COVID-19 and skin lesions was not reported, the most common cutaneous manifestation of COVID-19 was found to be maculopapular exanthem.¹

Skin lesions, like rashes and eruptions, are a common finding in viral infections. But what is more important is the appearance of chilblain like skin lesions, particularly on the toes, fingers, and heels. Hence this question arises, are COVID toes a symptom of COVID-19?

Case Report

When discussing whether COVID toes are a skin symptom of COVID-19 or not, let us consider a case report available.

Recently, some cases in Spain emerged with skin lesions that caught the attention of the dermatologists. A group of dermatologists has been treating urgent cases from home via an application made available by the Spanish Academy of Dermatology and Venereology (AEDV).²

Among some of the cases studied, it was noted that most skin lesions resolved by themselves without any treatment. While there were no signs of ischemia, some complained of pain or discomfort when palpated. In most cases, the skin lesions were not very symptomatic.² Most of the patients did not present with symptoms of COVID-19, and when shown, there was a mild fever of congestion. The oldest patient showed significant respiratory condition while others were in good health.²

The report of their patients with chilblain-like lesions, possibly COVID toes, was shared to increase awareness on the possible skin symptoms of COVID-19. According to the report, the cohort of six patients presented with multiple skin lesions, particularly on the extremities, fingers, heel, soles, and toes, which appeared similar to chilblains. The patients were asymptomatic and there were no COVID-19 symptoms noted. Very few of them had a fever, cough, and congestion, 3 to 4 weeks before, while some had risky contacts. Two of the six patients had shown positive test weeks before.²

While there is no clear evidence that COVID toes are skin symptoms of COVID-19, the occurrence of these chilblain-like lesions during the ongoing pandemic raises a suspicion. In other countries like France and Italy too, cases of similar skin symptoms in teenagers and young people were noted.²

It was finally hypothesized that COVID toes could be one of the late skin symptoms of COVID-19. As the skin lesions were not noted in the beginning but appeared weeks after reaching the peak of infection. Also, most patients reported well-matched symptoms and exposure to high-risk contacts, regarding COVID-19, weeks before the appearance of skin lesions. The negative PCR tests results could be due to no COVID-19 infection, false-negative reports or it was a late symptom of COVID -19 where the PCR had already reversed to negative.²

COVID Toes and COVID-19

While some reports suggest that red, purple, chilblain like lesions are noted in some patients, COVID toes are considered as another tell-tale symptom of COVID-19. It may be because every patient reacts to the virus differently. Also, their present health condition, existing medical conditions, and reaction to the disease and drugs may vary. As the skin lesions are noted on the toes, heels, and fingers and considered to be related to COVID-19, the name is given as COVID toes. It was also discussed that COVID toes or the chilblain-like lesions were mostly noted in children, teenagers, and young adults.

Although COVID toes have not been officially included in the list of COVID-19 symptoms, some dermatologists have shared their patient experiences and case reports in this favor. It is not clear whether the patients were infected with COVID-19 as the reports were limited. Even if COVID toes are a symptom of COVID-19, possibly a late symptom, they are manageable. All the necessary actions are taken and patients with such skin lesions have shown improvement.

Experts suggest that it is common for someone to have a viral infection along with a skin rash or blotchy areas on the body. It could be a way in which a person reacts to the infection. Such skin lesions are common and also noted in other viral infections like measles. Skin rashes can also be a result of antibiotics. However, presently there is no specific pattern of skin rash observed in COVID-19.³

COVID toes seem to be a different kind of symptom and are not clear what causes it. A common pattern reported by some people was red lesions appearing on the soles. This could be a skin reaction, occurring due to a small clog or micro clots in the blood vessels in the toes. People with severe illnesses, getting treated in ICU also show similar skin lesions. This discoloration of toes is mostly due to the clogging of vessels in such patients. It is still unclear if COVID toes are a symptom of COVID-19 and how it is related to the severity of the virus.

What Do You Need To Know About Covid Toes?

The commonest symptoms of COVID-19 continue to be the most looked for symptoms. If you notice any symptoms of fever, cough, shortness of breath, you must report to the local authorities, as advised earlier. Also, practicing social distancing norms, hand washing, and wearing a face mask helps to prevent the spread of infection.

Whether or not COVID toes are symptoms of COVID-19, there is no need to panic. While people must continue taking all the preventive measures advised for COVID-19, it is also important to keep a watch on the appearance of any skin symptoms or chilblain-like lesions on the toes and fingers. If you notice any red, purple, skin lesions, or blotchy spots like those of chilblains over the toes, fingers, heels, soles that look like COVID toes, report to your healthcare provider. Follow their advice and get yourself tested if needed.

The healthcare providers and dermatologists to need to inform the local authorities if any chilblain -like lesions or COVID toes are observed in patients with or without COVID-19 symptoms.

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Are COVID Toes A Skin Symptom Of COVID-19?