Itchy Red Toe Rashes could Indicate Virus

Skin doctors suddenly are looking at a lot of toes – whether by emailed picture or video visit –as concern grows that for some people, a sign of COVID-19 may pop up in an unusual spot.

Boston dermatologist Esther Freeman expected to see skin complaints as the pandemic unfolded – various kinds of rashes occur when people get very ill from other viruses.

“But I was not anticipating those would be toes,” said Freeman of Massachusetts General Hospital, who has viewed via telemedicine more toes in the last several weeks than in her entire career.

They're being called “COVID toes,” red, sore and sometimes itchy swellings on toes that look like chilblains, something doctors normally see on the feet and hands of people who've spent a long time outdoors in the cold.

Don't race to the emergency room if toes are the only worry, said the American Academy of Dermatology.

Earlier this month, it issued advice that a telemedicine check is the first step for people wondering whether they have “COVID toes” and who have no other reason for urgent care. Doctors then should decide if the patient should stay in home isolation or get tested. As this bewildering virus continues to spread, less common symptoms are being reported including loss of smell, vomiting, diarrhea and increasingly, a variety of skin problems.

In one report, dermatologists evaluated 88 COVID-19 patients in an Italian hospital and found 1 in 5 had some sort of skin symptom, mostly red rashes over the trunk. In another, Spanish doctors reported a series of 375 confirmed virus patients with a range of skin complaints, inclding hives, chickenpox-like lesions and toe swellings.

Pictures of reddened toes and rashes all over social media and doctor chat groups have “already enabled the rapid recognition of skin signs by dermatologists. It is now time for rigorous science” to understand the link, Dr. Kanade Shinkai of the University of California, San Francisco wrote in a JAMA Dermatology editorial.