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There is still a lot to learn about the new coronavirus, including a wide range of symptoms that seems to be expanding. Common symptoms of respiratory illness include fever, cough, shortness of breath, and chills, but some doctors have reported less obvious symptoms in some patients, including what some call “COVID toes” and other skin ailments.
Esther Freeman, director of Global Health and Dermatology at Massachusetts General Hospital and an assistant professor at Harvard Medical School, said “COVID toe” cases resemble pernio or chilblains, a condition of inflamed blood vessels caused by low temperatures.
“We are seeing this inflammatory response that we would normally see when someone was exposed to the cold temperature … like someone who has been playing outside in wet socks,” Freeman told CBS News. “However, in this environment, we see it in hot climates and we see it in patients who have been indoors and taking refuge in place.”
Freeman said it is not unusual for a virus to cause a rash, so most dermatologists are not surprised that COVID-19 can cause skin symptoms. “What amazes me are these ‘COVID toes’, these hinge-like injuries … because we haven’t seen that many reports of these on other viruses.”
Freeman is a practicing dermatologist at Massachusetts General Hospital who has been treating patients through telemedicine video appointments. “I’ve seen more toes in the past two weeks in my clinic than in my entire previous combined career,” said Freeman, a member of the COVID-19 task force at the American Academy of Dermatology (AAD).
In addition to seeing skin symptoms from his own patients, Freeman has also received examples of these symptoms from healthcare providers around the world. The AAD COVID-19 working group established a International registry for physicians to submit examples of dermatological manifestations of COVID-19, to help study these symptoms. Doctors from 21 different countries have so far sent information to the registry.
Freeman said “COVID toes” have been seen in children and adults. Sometimes they are present along with more typical coronavirus symptoms, and sometimes they are the only symptom the patient experiences. “Actually, about half of the record is experiencing more than just toes,” Freeman said.
Some doctors have also reported seeing skin conditions that look like morbilliform rashes (similar to measles), hives, or chicken pox.
In fact, one of the first case series of dermatological manifestations included 18 Italian patients with various skin abnormalities, such as redness, hives, and skin rashes, often on their torsosus, Freeman and colleagues write in the Journal of American Academy. of Dermatology.
Freeman says that his own patients tend to come to her with two main concerns. “The first thing they want to know is ‘My fingers are purple, am I really going to get sick?’ I can reassure you that most of the patients in our registry, most of the data that we are seeing, are very good, “Freeman said. “The second thing my patients want to know is: ‘Am I potentially infectious? Could I be infecting my family members?'”
Freeman said it is important to be cautious because some “COVID toe” patients may still be infectious and should talk to their doctor about getting a coronavirus test.
“The general message I want to say to the public is not to panic,” Freeman said. “Most of our patients who have these ‘COVID toes’ are doing extremely well.”
“If you need to go to the emergency room because you are sick or have other symptoms that you need to be evaluated for, that’s fine. But if the only symptom you have are purple toes, you don’t need to rush to the emergency room,” Freeman said, adding that if a patient experiences foot or skin abnormalities, they should speak to their doctor.
JAAD
A team of dermatologists from Brussels, Belgium and Portland, Oregon, have also studied skin and toe infections in connection with COVID-19. In a case report published in JAAD, they say it’s important for dermatologists to recognize the signs.
The researchers write about a 23-year-old man who had painful, “sharp-appearing” purple plaques on his toes and the outside of his feet for three days. For several days before that, she also had a mild fever and a dry cough.
After a complete skin examination, the patient tested positive for COVID-19. The researchers say he was diagnosed with “chilblains induced by COVID-19 infection,” the medical term for skin sores. Similar cases have been observed by French and Belgian dermatologists, but had not been previously reported due to lack of evidence, the researchers said.
“Young patients presenting with chilblains do not have sufficient criteria to allow a COVID-19 PCR test,” according to the study. “Due to the recent outbreak of chilblains, concurrent with the increase in cases of COVID-19, COVID-19 has been widely suspected as the etiology” or the cause, they write.
This study examined cases of COVID-19 chilblains in children and young adults, whose feet have been more affected than their hands.
Chilblains may be the inaugural symptom of COVID-19, and fever and dry cough may be minimal or even absent, according to the study.
