A New Symptom to Watch Out For – COVID-19 Keeps Us on Our Toes in More Ways Than One

Even without the usual symptoms like loss of smell, shortness of breath, and chest pain, you or your child could have something called “COVID toe."

Several experts think that chilblain-like sores on toes could be a sign of COVID-19 – if you or a loved one are experiencing painful or itchy red lesions on the toes, see a dermatologist and get a COVID-19 test. While chilblains are caused by cold or damp weather in the winter, these COVID-19 lesions could happen in warm weather.  

COVID toe/Photo courtesy of Dr. Amy Paller, Northwestern University)

“COVID toe” mainly affects the feet of healthy children, adolescents, and young adults. First, the toes swell and become red and shiny on one or both feet; then painful, red, bumpy lesions develop on several toes before changing color from red to purple. Those afflicted experience discomfort, complaining that they can’t wear socks or shoes and that walking is difficult. A group in Spain reported several patients with such lesions in April 2020.

While many viruses cause rashes like chickenpox, measles and rubella, this rare skin problem associated with COVID-19 includes a morbilliform – a pink, bumpy rash or hives. Toe lesions are unusual for any virus. 

The COVID-19 Link

Experts are baffled as many patients displaying these lesions tested negative for COVID-19 in PCR and antibody tests. However, many doctors think that the connection to COVID-19 is real, and actually a delayed response to an earlier infection. The lesions could be a sign of a mild or asymptomatic infection, or even one that occurred several weeks before. It follows that SARS-CoV-2 might therefore be undetectable in the blood or nasopharyngeal swabs if the course of the disease was so mild that the virus hardly replicated.

Currently, no one is certain why it happens, but one possibility is that it’s related to the high production of a chemical called interferon I in some people, which reduces SARS-CoV-2 virus replication and antibody response but doesn’t prevent skin manifestation. Another potential answer is that the lesions stem from the increased blood clotting associated with COVID-19, with tiny clots and the inflammation of small blood vessels causing it. 

Of course, the virus may even be entirely unconnected, with the lockdown, a sedentary lifestyle and bare feet on cold indoor floors being the true culprits. However, there’s biopsy evidence that SARS-CoV-2 is present in these toe lesions, making it highly likely that they are a manifestation of the disease.

What to Do If You or Your Child Has “COVID Toe”

Just like with the better-known symptoms associated with COVID-19, you should consult your primary care physician to rule out other possible causes and get a COVID-19 test. 

Generally, patients experience a benign clinical course and should stay home and recuperate. Some gained relief with hydrocortisone, antihistamines, painkillers, and ice. The good news is that the toe lesions will disappear within a few weeks.

Dr. Michelle Epstein
Michelle Epstein is a medical doctor graduated from the University of Alberta in Canada, who has specialised in Internal Medicine at the University of British Columbia and Allergy and Clinical Immunology at Yale University. Since 2004, she has been a Lab Leader at the Medical University of Vienna’s Division of Immunology.

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