Skin doctors suddenly look at a lot of toes – be it photo or video via email – as concern grows that for some people, a sign of COVID-19 may appear in an unusual place.
Boston dermatologist Esther Freeman expected to see skin complaints as the pandemic unfolded – various types of rashes occur when people get very sick from other viruses.
“But I didn’t expect them to be,” said Freeman of Massachusetts General Hospital, who has seen more toes by telemedicine in recent weeks than during his entire career.
They are called “COVID toes”, red, painful and sometimes itchy swelling on the toes that looks like frostbite, something doctors normally see on the feet and hands of people who have spent a lot of time in the sun. outside in the cold.
Do not rush to the emergency room if the toes are the only concern, said the American Academy of Dermatology.
Earlier this month, he issued a notice that a telemedicine checkup is the first step for people wondering if they have “COVID toes” and have no other reason for urgent care. Doctors must then decide whether the patient should remain isolated at home or be tested.
The most common symptoms of coronavirus are fever, dry cough, and shortness of breath – and some people are contagious despite the absence of symptoms. But as this puzzling virus continues to spread, less common symptoms are reported, including loss of smell, vomiting and diarrhea, and increasingly, a variety of skin problems.
In a report, dermatologists evaluated 88 COVID-19 patients in an Italian hospital and found 1 in 5 had some sort of skin symptom, mainly red rashes on the trunk. In another, Spanish doctors reported a series of 375 confirmed virus patients with a range of skin problems, from hives to chickenpox-like lesions and swelling of the toes.
Photos of red toes and rashes on social media and discussion groups with doctors “have already enabled rapid recognition of skin signs by dermatologists. Now is the time for a rigorous science “to understand the connection, wrote Dr. Kanade Shinkai of the University of California at San Francisco in a recent JAMA Dermatology editorial.
Freeman of Boston maintains an international COVID-19 registry for physicians to report cases of skin symptoms related to the virus. Of 500 reports since late March, about half are frostbite-like spots on the feet, she said.
Frostbite, what doctors call “pernio,” is an inflammatory reaction. When pernio-like reactions appear in patients infected with a coronavirus, this is one of the many mysteries. For some people, this is the first, if not the only, symptom they notice. Others see the toe problem at the same time or even a few weeks after experiencing more frequent and severe COVID-19 symptoms.
This is also seen in young people, according to Dr. Amy Paller of Northwestern University, which is part of a pediatric dermatology registry that also collects images from patients’ toes.
Among the theories: is it just inflammation caused by infection instead of cold? Does the virus irritate the lining of the skin’s blood vessels or perhaps cause microscopic blood clots?
“The public health message is not to panic,” said Freeman, noting that most of the toes she saw did not get seriously ill.
Are they contagious? “We can’t say it just by looking at your toes,” she said. Other medical conditions, such as lupus, can cause similar blemishes – another reason why doctors should discuss the overall health of each patient and the next steps for testing or other necessary care.
The Associated Press’s Department of Health and Science is supported by the Department of Science Education at the Howard Hughes Medical Institute. The AP is solely responsible for all content.