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'COVID Toes,' other skin conditions could be sign of coronavirus infections

Northwestern Medicine dermatologist explains the symptoms

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We've all heard about the fever, cough and shortness of breath as being the hallmark symptoms of COVID-19.

But now, research is emerging that skin conditions could also signal a coronavirus infection.

According to Jill Cotseones, DO, FAAD, medical and cosmetic dermatology at Northwestern Medicine Central DuPage Hospital, "COVID toes" is the term being given to red-purple toes that have been reported in patients that are COVID-19 positive.

They have been reported in both children and adults and do not typically correspond to the severity of the COVID-19 infection.

"Typically, 'COVID toes' involves 1-3 digits (either fingers or toes) and presents as red-purple to blue skin lesions that are often painful," Cotseones explained. "They have a very similar appearance to pernio, which is a skin condition that often develops after exposure to cold temperatures."

The skin condition often shows up prior to the more typical symptoms, and could even be the only symptom a patient presents with, Cotseones said. And as the infection progresses, the skin lesions can blister or form a crust on the skin.

"A lot is unknown about the virus, but we are finding out more each day. We know that there is an increased risk of vascular occlusive phenomena or clotting in very sick patients with COVID- 19," she explained. "We suspect that this is secondary to the extreme immune response triggered by the virus, which may result in damage to the lining of the blood vessels and clot formation. As a result, this may theoretically lead to decreased blood flow of the acral skin surfaces; although further investigation is warranted."

The good news is that COVID toes often resolve without treatment when the coronavirus infection clears. Cotseones said that if a patient has pain, topical corticosteroids have been used anectodally to improve the lesions.

"More importantly, “COVID-toes” may be a red-herring that you have an infection with COVID-19 and if exhibiting the acute onset of these skin findings, viral testing may be warranted," she said. "Other skin manifestations being reported from COVID-19 are a net-like red rash on the extremities called livedo reticularis, hives, petechiae (an eruption typically seen with low platelets), and a chicken-pox like eruption on the body."

Cotseones said that not all red-purple toes indicate COVID-19, and anyone who notices those symptoms should see their doctor, especially if they persist or worsen.

"Similar skin lesions can be associated with chronic autoimmune or vascular disease, infection, or be suggestive of a medication reaction," she said.

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