“The way I explained it to my patients is COVID toes are almost too much of a good thing,” Freeman says. They also carried high levels of proteins called type I interferons that are a first line of defense against viral infections. The study showed that compared to healthy individuals, COVID toe patients had high levels of immune proteins called autoantibodies in their blood that erroneously damaged their own healthy tissues.
#Covid rash on foot skin#
The researchers studied the blood and skin samples of 50 patients-several of whom had COVID-19 symptoms like cough, fatigue, and fever-who had such chilblains for the first time in April 2020 and tested negative on a PCR test. In some studies, researchers detected the presence of virus particles in the skin biopsies of COVID toe patients, suggesting a SARS-CoV-2 role, but experts aren’t convinced by those findings.Ī study published in October last year in the British Journal of Dermatology was among those suggesting an aggressive immune response to a SARS-CoV-2 exposure may be responsible for COVID toes. “That's what has made it so hard and confusing to be able to say if it is COVID associated,” Arkin says. This despite a spike in chilblain cases in 2020 compared to those recorded in the region between 20. Similarly, a study conducted in Northern California found that only 17 of 456 patients diagnosed with chilblains between April and December 2020 tested positive for COVID-19 using a PCR test, and only one of 97 who had their blood sampled for SARS-CoV-2-specific antibodies tested positive. However, many COVID toe patients, including several of Arkin’s young patients, had a negative PCR test and lacked antibodies against SARS-CoV-2, suggesting that they probably never had COVID-19.
The lesions-which typically develop after repeated exposure to cold and damp conditions and can also affect fingers, heels, ears, and nose-usually appeared between one and four weeks after a positive COVID-19 test. Many of the affected patients-often children and young adults-never developed typical COVID-19 symptoms such as cough, fever, and muscle pain. "Chilblains have only rarely been associated with viruses," she says. “If you had asked, say, 100 dermatologists before the pandemic what rashes would you expect to see with a virus, pernio chilblains would not have made the list-it would not have made the top 50,” says Freeman. Similarly, dermatologists have now identified an array of skin conditions, including chilblains, associated with COVID-19. These symptoms arise as the body’s immune system responds to the virus or to virus-damaged skin cells. It isn’t uncommon for viral infections, including measles, chickenpox, and mononucleosis, to cause a rash of blisters, small bumps, or patches on different parts of the body. In the last two years, scientists have studied thousands of pandemic chilblains or ‘COVID toe’ cases around the world, examining blood and skin biopsies to answer that question. Physicians began wondering if the chilblains were due to SARS-CoV-2, the virus that causes COVID-19. “At its most severe, it’s so painful that some patients can’t put their shoes on for a couple of weeks.” “At its most mild, people complain of it being like a mild itch,” says Esther Freeman, a dermatologist and epidemiologist at Harvard Medical School. In some unusual cases, however, the condition lasted for months and even up to a year or more.
So-called chilblains typically started out with a burning itching sensation on the toes followed by the discoloration, which often resolves without treatment within a few weeks. “I was completely shocked.”ĭermatologists in other parts of the U.S., and around the world where COVID-19 cases were rising, were also reporting cases of people with red-purple lesions often on their toes.
“My urgent clinics-either telemedicine or in-person-were suddenly filled with patients with purple toes, complaining about swelling, blistering, discomfort, and pain,” Arkin says. But in April 2020, when COVID-19 cases first surged, she saw 30 chilblain patients. Lisa Arkin saw more swollen, discolored toes during the early months of the pandemic than she had during her entire career.Īrkin, a pediatric dermatologist at the University of Wisconsin-Madison, treated just a couple of patients with temporary skin lesions called pernio, or chilblains, each year.
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