COVID toes is a rare but recognized symptom associated with COVID-19 infection, characterized by swollen, discolored toes that often appear red, purple, or purplish-brown. This condition causes inflammation resembling chilblains, presenting as painful, itchy, or numb toes and sometimes fingers. While the exact cause of COVID toes remains uncertain, research points to it being an immune system response to the SARS-CoV-2 virus, potentially involving inflammation of small blood vessels in the extremities. COVID toes typically last one to two weeks and usually resolve without specific treatment, although in severe cases medical intervention may be necessary.
What Are COVID Toes?
COVID toes manifest as skin changes primarily on the toes but occasionally on the fingers, appearing as red or purplish discolorations, swelling, and sometimes blisters or raised bumps. The toes may feel painful, itchy, or numb, and the condition resembles chilblains — an inflammation of small blood vessels triggered by cold exposure but occurring here as a pseudo-chilblain phenomenon linked to COVID-19 infection. Such discoloration can appear as bright red initially then turn purple or purplish-brown, impacting both light and dark skin tones differently, with dark skin showing brownish-purple spots or swelling.
Causes and Mechanisms
The precise etiology of COVID toes is still debated in the medical community, but several contributing factors have been proposed:
- Immune Response: One leading hypothesis is that COVID toes occur as a result of the body’s immune response to the virus, where inflammation affects small blood vessels in the toes and feet, causing swelling and discoloration. This immune-mediated inflammation may be the body’s antiviral response.
- Vascular Effects: SARS-CoV-2 may directly or indirectly affect blood vessels, contributing to these cutaneous vascular changes seen as COVID toes.
- Similarity to Chilblains: The condition resembles chilblains, which typically arise from cold exposure causing painful inflammation in extremities. COVID toes represent a “chilblain-like” lesion but seemingly triggered without cold exposure.
- Underlying Health Conditions: Individuals with poorer circulation, such as in diabetes or peripheral artery disease, or those immobilized during hospital stays, may be more susceptible to developing COVID toes.
Symptoms and Duration
Typical symptoms of COVID toes include:
- Red or purple discoloration on one or more toes or sometimes fingers
- Swelling and sometimes puffiness of the affected digits
- Itchiness, burning sensation, pain, or numbness
- Raised bumps, patches of rough skin, or blisters in some cases
- Sometimes pus under the skin (rare)
Most people experience resolution of these symptoms within 1 to 2 weeks, although persistent or recurrent cases lasting months have been reported.
Diagnosis
Diagnosis largely depends on clinical examination and history of recent or concurrent COVID-19 infection. Though some patients may have tested negative for COVID-19, the diagnosis can be suspected based on characteristic appearance and timing during the pandemic waves.
Treatment and Management
There is no specific antiviral treatment for COVID toes since it is mostly a self-limited inflammatory response. Management focuses on symptomatic relief and monitoring for complications:
- Pain relief with over-the-counter medications like ibuprofen or acetaminophen
- Antihistamines for itching
- Topical corticosteroids (such as hydrocortisone cream) to reduce inflammation
- Elevating the foot and applying cold compresses to help reduce swelling
- Wearing loose, comfortable footwear to avoid further irritation
- In severe or persistent cases, medical consultation is recommended; some treatments like cilostazol have been reported to help by relaxing blood vessels.
If underlying conditions such as diabetes or peripheral artery disease are present, they should be managed appropriately to prevent worsening of symptoms.
Prognosis and Concerns
COVID toes are generally benign and not life-threatening, but they may signal an active immune reaction or potential vascular involvement. They can cause discomfort and impact quality of life temporarily. Importantly, the presence of COVID toes should prompt consideration of COVID-19 infection, even if respiratory symptoms are absent or mild. Patients experiencing unusual skin changes should seek medical advice to rule out other causes and receive appropriate care.
Summary
COVID toes describe a distinctive, chilblain-like skin condition affecting the toes (and sometimes fingers) linked to COVID-19 infection. It involves swelling, discoloration, and sometimes pain or itchiness, caused primarily by the body’s immune response to the virus leading to vascular inflammation. Mostly seen in children, teens, and young adults, the condition usually resolves on its own within a couple of weeks with supportive care. Awareness of COVID toes can aid in early recognition of COVID-19 cases and guide symptomatic treatment and supportive management.
This understanding is continuously evolving with ongoing research into the dermatologic and vascular effects of the SARS-CoV-2 virus.