There have been a number of reports of skin lesions associated with Covid 19 and this data is being collated by the international research community. ‘Covid toe’ is one of these. It is a chilblain-like lesion, which is thought to be caused by the virus damaging the small blood vessels. Initially Covid toe lesions appear as a reddish and papular (small raised bumps), very much like a chilblain and after about a week or so become flattened and purpuric (purple spots due to damage in the small blood vessels).
They can feel itchy, uncomfortable or even painful. Those affected are often, but not exclusively, younger people and having none or very few symptoms of Covid 19. The appearance of ‘Covid toe’ seems to occur in the later stages of the viral infection. If this is the only symptom noted it would be wise to be tested.
‘Covid toe’ can easily be mistaken for chilblains, an allergic reaction or contact dermatitis, so careful history needs to be taken considering recent general health, symptoms of Covid, history of Reynaud’s disease, allergies, recent weather conditions, and social history.
Care needs to be taken in protecting the affected toes from large range temperature changes, e.g. getting into very hot baths, as more microvascular damage may occur.
If the chilblain-like lesions do not resolve within 30 days it is recommended that screening for underlying causes is undertaken, as these lesions appear like blood vessel damage seen in connective tissue disease. These may have been triggered by Covid -19.
International Journal of Dermatology/Volume 59, issue 6