Stains on the toes and skin rashes join strange new symptoms of coronavirus

A few weeks ago, the peculiar symptom of loss of smell and taste was reported as an early symptom of COVID-19 infection. This generally preceded lung symptoms, the most prominent finding in infection. More unexpected symptoms are now being reported, such as diarrhea, heart involvement, strokes, and skin rashes.

In a report from Italy, 20% of patients had a rash, half at the onset of illness and the other half later. There was no specific type of rash; some were like hives, others a lace pattern called livedo reticularis, and others were described as “chilblains” or “pernio,” with lesions similar to frostbite, and some were even like chickenpox.

What should you do if you develop such a strange skin rash? If you are not sick, quarantine for fourteen days, in case you have COVID-19. There is no point in going to the doctor for this: we do not yet have accurate tests to diagnose COVID-19, and you risk infecting yourself or others by unnecessarily leaving. You should seek care immediately if you are seriously ill, but not otherwise.

Sebastiano Recalcati, MD, from Alessandro Manzoni Hospital in Lecco, Italy, described some of the first cases. In his series, the rash was more common on the trunk and there was little or no itching. In a more recent series, injuries were mainly to the fingers and toes. Biopsies showed some lymphocytic infiltration (type of blood cells) around the blood vessels.

Dr. Ramon Grimalt, a professor of dermatology at UIC-Barcelona, ​​also provided preliminary reports from Spain that children and adolescents were being seen with hips, or chilblains, from the fingers and toes. These injuries are caused by cold, which causes inflammation of the blood vessels in the skin in some people. These children generally had little or no respiratory or other COVID-19 symptoms. The General Council of Official Colleges of Podiatrists of Spain opened a register to collect all these unusual cases. They cautioned that while these skin lesions were benign (not a problem in themselves) they were notable as a sign of asymptomatic coronavirus infection. The American Academy of Dermatologists has its own registry and is seeking submissions from healthcare professionals.

The lesions were described as “pseudo-freezing” by the National Union of Dermatologists-Venereologists (SNDV) (another European group), because these sometimes painful injuries appeared without exposure to cold. In an interesting case in “Amici DermPed” ^⁠the boy’s mother and sister had more classic COVID-19 symptoms, with fever, cough, and shortness of breath the week before the development of skin lesions on the feet.

A more unusual eruption was observed in Bangok. There, one patient developed a skin rash called a petechial rash (like small bruises) and a low platelet count. These symptoms are typical of dengue fever, a common viral infection transmitted by mosquitoes there, so it was assumed that it was causing the patient’s symptoms. Only later, after the patient was admitted to a tertiary medical center with respiratory problems, was he diagnosed with COVID-19.

Clinicians are warned of another masked man. The hinge-like rash, especially if there are painful pustular blisters on a reddish base, could be mistaken for community-associated MRSA (methicillin-resistant Stapylococcus aureus) Injuries In practice, it had become a common understanding that if a person complained of a painful “spider bite”, they were more likely to have an MRSA infection.

Dr. Ilan Schwartz, assistant professor of infectious disease at the University of Alberta, has an excellent Covid toe thread that begins here.

Each of these rashes now seen with COVID-19 are signs of blockage or inflammation in small blood vessels. Interestingly, patients with such rashes, especially children, appear to have a milder course so far.

This seems a bit surprising to me, as we are now seeing that a common thread in the most severe cases is abnormal coagulation. This is the reason why the use of anticoagulants is increasingly recommended for patients with COVID-19. However, people develop clots even with blood thinners.^⁠. Severe blows^⁠ in young adults it was described as yet another complication of COVID-19, although this was in otherwise healthy young adults.

Mild coagulation is seen in the lungs, kidneys, heart, and extremities. Broadway actor Nick Cordur^⁠He had to have his leg amputated due to virus clotting and he had quite a few complications.

We do not clearly understand why these clots are occurring. We know that the receptor for SARS-CoV-2, the virus that causes COVID-19 infection, is found in the lining of blood vessels (vascular endothelial cells)^⁠. The receiver is called angiotensin-converting enzyme 2 (ACE-2). So perhaps this is why so much cardiac involvement is seen with COVID-19. In a small Washington state study, a third of patients^⁠ Developed cardiac involvement.

While our understanding of COVID-19 has progressed relatively quickly, there are still many things we don’t know. This virus seems to be acting like syphilis, “the great imitator,” with so many different manifestations in people, and we don’t know why that is true. Surprisingly, the CDC has just listed the symptoms of the coronavirus, but it does not list these rashes that have been appearing for weeks.

COVID can cause a wide range of symptoms in people, but we don’t know why there is so much variety. Inflammation of the blood vessels seems to be a common denominator. Why people with skin rashes can often have mild courses is a great mystery.