COVID Toe and Other COVID-19 Skin Conditions
When the novel coronavirus first emerged, the public was warned about the major signs and symptoms: cough, fever, and shortness of breath. Now that the virus has spread around the globe, physicians and researchers have been able to study the disease and how it affects different people in different ways.
Currently, physicians have a more nuanced understanding of how the virus may manifest itself in those who become seriously ill, as well as those who have mild symptoms.
Dr. Joanna Harpis a dermatologist at ֱ and specializes in complex medical dermatology and skin disorders related to internal disease. She helps treat patients hospitalized for COVID-19, as well as care for outpatients viavideo visits.
What is COVIDToe? Is it serious?
Dermatologists around the world have noticed an increasingnumber of patients presenting with an unusual rash that may be related toCOVID-19:red-purple, tender or itchy bumpsthat developmostly on the toes, but also on the heels and fingers.The skin findingsresembleperniosisor chilblains,a rash that typically is associated with exposureto cold conditions. According to Dr. Harp, “Theseskin findingsare typically linked to cold weather.Soseeing so much of it now is very unusual.Dermatologists think it may be one of the ways thebody responds to the COVID-19 virus.”
Since COVID-19 is a new disease, there is very little data about it, including about COVID toe. However, physicians have observed that the majority of patients who develop COVID toes do not become severelyillfrom the virus.
“The majority of COVID toe patientsseem to be completelyasymptomatic or haveonlymild symptoms,” reassured Dr. Harp. “These patients often recover fully at home.”
What should I do if I have COVID toe?
“If you suspect that you have COVID toe,” said Dr. Harp, “it could be a sign that you have COVID-19 and may be infectious. I would be extra careful.”
Dr. Harp recommended that you schedule a time to speak with a primary care physician or dermatologist viaavideo visitto further discuss your symptoms and skin findings.
Can I schedule a video visits for COVID toe?
“I think a video visit is appropriate and can be done safely,” explained Dr. Harp. “I think they’re great. There are certain things that we can be reassuring about—for many patients the best treatment is to quarantine.Even if we can’t be definitive, we have a good idea how to triage. We are ableto escalate carefor the patients that really need it.”
If you suspect you have COVID toeand schedule a video visit, you will be asked to take pictures of your skin and send the photos to your dermatologistor primary care doctorbefore the appointment. “During the video visits, I review the symptoms andphotographs and also often look via the video at the skin findings live.The still imagesare often better quality than we can see in the video,so they are a helpful addition,” she detailed.
It is still unclear how often COVID toe develops in patients with COVID-19 and why. It is important to know that the skin findings seen in COVID toe can also be caused by other viruses or just develop on their own,so this skin finding does not necessarily mean a patient has COVID-19.However, the skin finding is unusual enough as it becomes warmer that this rashwarrantsa virtual discussion with a physician, close monitoringfor othersymptoms, as well as extra caution to prevent potentially exposing others to the virus.
We are still learning aboutCOVID toe symptoms,but most patients experience the skin rash and symptoms for several weeks beforeresolution.The rash generally does not require treatment,butcertain treatments can be consideredif the findings are very itchy or painful.
Other COVID-19 skin conditions
Patients who are hospitalizedwith more severe cases ofCOVID-19 are exhibiting several skin conditions other than COVID toe.
One condition is a “lacy,purple, bruise-likerash that occurs on critically ill patients,”Dr. Harpsaid. “It usually occurs on the hands and feet andmayextend onto the arms and legs.This rashmayindicate clottingin the blood vessels of the skin.We are learning that COVID-19 disease seems to be associated with a higher risk of blood clotting in many organs including the skin, the larger blood vessels in the legs and lungs, and even in the brain causing strokes.”
Other rashes that have been reported in COVID-19 include red, bumpy rashes, hives, and small water blisters.“As of now,” explained Dr. Harp, “we don’t really know if these rashes areactually from the virus itself or possibly represent mild allergic reactions to medications.”
Dermatological care is important, still available
“The skincan bea window into what is happening internally,” explained Dr. Harp. “There is so much we don’t know about COVID-19, but we are learningabout variousskin conditionsthat may beassociated with the virus.”
If you are concerned that you may have COVID toe, another skin condition associated with COVID-19, or have other symptoms of the virus, be sure to reach out to a physician at ֱ toschedule a video visit.
ֱ dermatologists are seeing existing and new patients virtually about skin conditions related and unrelated to COVID-19. “For patients who live within New York state, we are offering dermatology video visits to new patients,” explained Dr. Harp.
All of us atֱunderstand that this is a difficult time for all New Yorkers. As experts in immunology, psychiatry, pulmonary medicine, and critical care medicine, we are working diligently to provide the best possible care to patients in need.
We are available to all New Yorkers who have questions or concerns. Please call our hotline at (646) 697-4000 for information about COVID-19 or read ourpatient guide.