If you had asked dermatologist Esther Freeman, M.D., last year what type of skin ailment a future viral pandemic might bring about, she never would have predicted red- and purple-colored toes that swell, burn and itch. But that’s exactly what she and other experts are seeing in patients with coronavirus infections, leading this unusual symptom to be dubbed “COVID toes.”
“The good news is, they do go away,” says Freeman, director of Massachusetts General Hospital Global Health Dermatology and assistant professor of dermatology at Harvard Medical School, who is also overseeing an international registry that catalogs the dermatological manifestations of COVID-19. “So we’re not seeing that this is going to cause permanent damage.”
Another plus: The majority of people with COVID toes — which Freeman likens to chilblains (also called pernio), an inflammatory skin condition that often occurs after exposure to very cold temperatures — don’t experience other symptoms of a coronavirus infection and don’t require hospitalization for care. “Many patients are developing these toe lesions well after their infection, or they’re otherwise completely asymptomatic, except for the toes,” she adds.
Though most cases of COVID toes occur in the feet, the hands can be affected, too. Rashes similar to those that result from hives and chicken pox have also been reported in people who test positive for the coronavirus.
As for how and why these skin conditions are happening, Freeman says, “Our knowledge on this is still evolving.” It could be an inflammatory response to the virus, for example, or even a result of small blood clots in the blood vessels of the skin. (Medical experts have reported concerning clotting issues in patients with COVID-19.) “I think that over the coming months, we’re going to learn a lot more about why this is happening,” Freeman adds.
If you notice a lesionlike rash on your hands or feet, contact your doctor or dermatologist about your symptoms, since it could signify a coronavirus infection. That said, it’s important to keep in mind that “not everything on your toes right now is from COVID,” Freeman says. “There’s certainly lots of other things that can appear on the feet, and there’s things that can even look similar,” which is why it’s important to talk with an expert. There is no specific treatment for COVID toes, but a high-potency topical steroid might reduce inflammation.
One thing to note, however, is that a doctor won’t be able to tell if the virus is still active in your body just by looking at your skin. “So the safest thing to do is to follow CDC guidelines for self-isolation and to discuss with your board-certified dermatologist or other physician whether COVID testing might be right for you,” Freeman advises.