What Are ‘COVID Toes’?

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As the medical community scrambles to understand the various ways that COVID-19 infections manifests in the body, new possible symptoms continue to emerge. Last month it was widely reported that anosmia — a loss of smell ­— could point to a coronavirus infection, even if no other symptoms were detected. Now some doctors have turned their attention to a dermatological condition casually referred to as “COVID toes,” suggesting a possible link to the virus.

So far, the presumption of “COVID toes” is based on anecdotal evidence. The symptom presents as purple or blue lesions on a patient’s feet and toes. Ebbing Lautenbach, chief of infectious disease at the University of Pennsylvania’s School of Medicine, told USA Today that these lesions are “typically painful to touch and could have a hot burning sensation.”

Some doctors think “COVID toes” could be an early sign of infection, appearing in patients who are exhibiting no other symptoms. Lautenbach said, “This is a manifestation that occurs early on in the disease, meaning you have this first, then you progress.” Sometimes the condition goes away in fewer than ten days, he added, and sometimes it’s followed by other symptoms. According to Lautenbach, “COVID toes” are more prevalent in children and young adults, which the doctor suggests is due to their stronger immune systems. NBC 5 Chicago reports that the American Academy of Dermatology Association has asked health-care workers and physicians to document cases where patients “develop dermatologic manifestations” of the infection.

Though Lautenbach says “nobody knows” what causes “COVID toes,” the doctor suggested two possible explanations: that the lesions are an inflammatory response to the virus, or that they could be caused by blood clots, which sometimes occur in COVID-19 patients. Esther Freeman, a dermatologist at Massachusetts General Hospital in Boston, suggested the same explanations to Today, adding that “it could be a bit of both.”

Amy Paller, a dermatologist at Northwestern Medicine, told NBC 5 Chicago, “We don’t know for sure if it’s related to COVID-19, but when it’s so common right now during a pandemic and is occurring in otherwise asymptomatic or mildly affected patients, it seems too much of a coincidence not to be a manifestation of the virus for patients in their teens and 20s.” Paller added that a few patients who appeared to have the condition have tested negative for the coronavirus.

What Are ‘COVID Toes’?