Esther Freeman, director of global health and dermatology at Massachusetts General Hospital and assistant professor at Harvard Medical School, said the cases of “COVID toe” looked like pernio or frostbite, a condition of inflamed blood vessels caused by cold temperatures.
“We are witnessing this inflammatory reaction that we would normally see when someone has been exposed to the cold … like someone playing outside in wet socks,” Freeman told CBS News. “However, in this context, we see it in hot climates and we see it in patients who have been inside and sheltered there. “
Freeman said it is not uncommon for a virus to cause a rash, so most dermatologists are not surprised that COVID-19 can cause skin symptoms. “What surprises me are these” COVID toes “, these pernio-like lesions … because we haven’t seen as many reports of this in other viruses. “
Freeman is a practicing dermatologist at Massachusetts General Hospital who has seen patients via telehealth video appointments. “I have seen more toes in the past two weeks in my clinic than in my previous combined career,” said Freeman, who is a member of the COVID-19 working group of the American Academy of Dermatology (AAD ).
In addition to seeing skin symptoms in his own patients, Freeman has also received examples of these symptoms from health care providers around the world. The AAD COVID-19 task force has established an international registry for physicians to send examples of COVID-19 dermatological manifestations to help further investigate these symptoms. So far, doctors from 21 different countries have sent information to the registry.
Freeman said that “COVID toes” have been seen in children and adults. They are sometimes present with more typical coronavirus symptoms, and sometimes they are the only symptom that the patient experiences. “In fact, about half of the registry knows something other than toes,” said Freeman.
Some doctors have also reported seeing skin conditions that look like morbilliform (rash-like) rashes, hives or chickenpox.
In fact, one of the first series of cases of dermatological manifestations included 18 Italian patients with several skin abnormalities, including redness, hives and rashes, often on the chest, write Freeman and colleagues in the Journal of American Academy of Dermatology.
Freeman says her own patients tend to come to her with two main concerns. “The first thing they want to know is” my toes are purple, will I really get sick? “I can be reassuring that most of the patients in our registry, most of the data we are looking at, are doing very well,” said Freeman. “The second thing my patients want to know is:” Am I potentially infectious? Could I infect my family members? “”
Freeman said it was important to be careful, as some patients with a “COVID toe” may still be infectious and should speak to their doctor about having a coronavirus test.
“The general message I want to say to the public is not to panic,” said Freeman. “Most of our patients who have these” COVID toes “are doing extremely well.”
“If you have to go to the emergency room because you’re sick or have other symptoms that you need to be assessed for, that’s fine. But if the only symptom you have is purple toes, you don’t need to go to the ER, “said Freeman, adding that if a patient has skin or toe abnormalities, he should speak to his doctor.
A team of dermatologists from Brussels, Belgium and Portland, Oregon, also studied toe and skin infections in relation to COVID-19. In a case report published in JAAD, they say it is important that dermatologists recognize the signs.
Researchers write about a 23-year-old man who for three days had painful purplish “early onset” patches on his toes and on the outside of his feet. For several days before, he had also had a mild fever and a dry cough.
After a complete skin examination, the patient tested positive for COVID-19. Researchers say he was diagnosed with “frostbite induced by COVID-19 infection”, the medical term for skin wounds. Similar cases have been observed by French and Belgian dermatologists, but had not been reported previously due to the lack of tests, according to the researchers.
“Young patients with frostbite did not have sufficient criteria to allow a COVID-19 PCR test,” according to the study. “Due to the recent epidemic of frostbite, along with the increasing number of COVID-19 cases, COVID-19 has been widely suspected of aetiology” or cause, they write.
This study examined cases of COVID-19 frostbite in children and young adults, whose feet were more affected than their hands.
“Frostbite may be the first symptom of COVID-19, and fever and dry cough may be minimal, if not absent,” the study found.