What Are COVID Toes? Symptoms, Causes & Treatment for Coronavirus Toe Rashes

What Are COVID Toes?

COVID toes refer to skin rashes and lesions that have been appearing on the toes and feet of some people infected with COVID-19. This strange symptom has been dubbed "COVID toes" by dermatologists treating patients during the coronavirus pandemic.

COVID toes can look like a variety of rashes and lesions, including:

• Red, swollen toes
• Purple or blueish discoloration of the toes
• Blisters or bumps on the toes
• Chilblain-like inflammation and sores on the toes

The rashes associated with COVID toes are most often seen on the toes, but can also appear on the top of the feet or sides of the feet. The rashes can affect one toe, some toes, or all of the toes.

Who Gets COVID Toes?

Dermatologists have mainly seen COVID toes in younger patients, children, and otherwise healthy people. Most patients reporting COVID toes have had mild to moderate COVID-19 illness, with some being asymptomatic apart from developing lesions on their toes and feet.

Experts think there are a few reasons why younger COVID-19 patients seem to be developing these skin rashes more often:

• Their immune systems mount robust responses to the virus, which may manifest as skin inflammation
• They have mild disease and may overlook other symptoms like fever or cough
• Their feet are more prone to chilblains, which resemble some COVID toe rashes

What Causes COVID Toes?

Researchers and dermatologists think COVID toes are likely caused by inflammation or clotting issues brought on by COVID-19 infection.

Two leading theories are:

• Inflammation: The immune system response triggered by COVID-19 can cause inflammation far beyond the lungs, which may lead to rashes and lesions on the toes as the body tries to fight off the virus.
• Blood clots: COVID-19 can cause blood clotting disorders that reduce blood flow to extremities like the feet and toes, depriving tissue of oxygen and nutrients, and resulting in rashes and discoloration.

Additional factors like cold weather exposure or repetitive pressure on the feet may also play a role in COVID toes, especially in younger people more prone to chilblains.

Are COVID Toes Contagious?

The rashes and skin lesions associated with COVID toes are not contagious themselves. However, they are a symptom of COVID-19 infection, which is highly contagious.

People with COVID toes likely have, or have recently had, COVID-19 even if they don't exhibit other symptoms. They can unknowingly spread the coronavirus through respiratory droplets or touching surfaces with the virus on their hands.

So while you can't catch COVID toes directly from another person, people with COVID toes may spread the underlying COVID-19 infection.

Do COVID Toes Need Treatment?

In most cases, COVID toes resolve on their own without treatment in 1-2 weeks. Patients can follow these tips to manage COVID toes at home:

• Take over-the-counter pain relievers like acetaminophen or ibuprofen to reduce discomfort
• Soak feet in warm water to increase circulation and soothe skin
• Apply moisturizing lotion to prevent cracking and itching
• Avoid irritating the skin further by walking barefoot
• Keep toes warm with socks to avoid triggers like cold

For severe or persistent cases, doctors may prescribe topical steroids or other treatments to reduce inflammation and spur healing:

• Topical hydrocortisone can calm inflammation
• Antihistamines may help if hives or itching are severe
• Immunomodulating creams can dial back the immune response in the skin

Most importantly, anyone with COVID toes should follow up with a doctor for COVID-19 testing if they haven't already been tested. Getting an accurate diagnosis will inform isolation and treatment steps.

How Are COVID Toes Diagnosed?

Diagnosing COVID toes involves both assessing the skin lesions and testing for COVID-19 infection.

Dermatologists can often recognize COVID toes visually based on the characteristic rashes, but will also ask about:

• Timing - Did the rash appear recently or during COVID-19 infection?
• Symptoms - Is there discomfort, pain, itching or irritation?
• Medical history - Any prior skin conditions or allergies?
• COVID-19 status - Have they been tested? Are people around them infected?

Your doctor can perform additional exams to rule out other causes like eczema, athlete’s foot, gout, or allergic reactions.

To confirm a COVID toes diagnosis, PCR swab testing is needed to detect active coronavirus infection. Blood tests detecting antibodies can confirm past COVID-19 infection if swab results are negative.

When to See a Doctor

Consult a dermatologist promptly if you have any new rash or skin lesions on the toes or feet. Early assessment allows appropriate COVID-19 testing and tracking.

Seek emergency care right away if you have COVID toes along with:

• Shortness of breath
• Chest pain
• Bluish lips or face

These require prompt evaluation for blood clots in the lungs or low oxygen levels, which can be life-threatening complications.

Long-Term Effects of COVID Toes

For most patients, COVID toes are temporary and leave no lasting damage. However, in some cases, COVID toes can have long-lasting effects or indicate serious COVID-19 complications.

Potential long-term effects include:

• Discolored toes: In severe cases, the skin dies and leaves blackened, dead tissue. The damaged part of the toe may not regain normal color.
• Nerve damage: The blood vessels and nerves that supply the toes and feet can become permanently damaged. This may cause numbness or tingling.
• Ulcers: Inflammation and impaired circulation can cause painful sores and ulcers on the toes.
• Skin scarring: Severe blistering and skin injury can leave behind thick, scarred skin.
• Recurring lesions: Some people have flare-ups of COVID toes lesions even after recovering from COVID-19.

People hospitalized with severe COVID-19 are more likely to experience lasting effects of COVID toes. Seeking prompt treatment at the first sign of lesions can help avoid complications.

Can COVID Toes Cause Serious Problems?

In some cases, COVID toes may be a sign of underlying blood clotting issues or serious cardiovascular complications of COVID-19. These require urgent medical care.

Seek emergency treatment if COVID toes occur alongside:

• Chest pain or tightness
• Difficulty breathing
• Racing heart or palpitations
• Fainting or dizziness
• Leg swelling or pain

These can indicate blood clots in the lungs, heart issues, or other cardiovascular complications that can be life-threatening. Prompt medical care is essential.

Preventing COVID Toes

The best way to prevent COVID toes is to avoid contracting the COVID-19 virus. Follow all social distancing, masking, and hygiene guidelines in your area to protect yourself and others from the coronavirus.

If you do develop COVID-19, taking these steps may reduce your risk of getting COVID toes:

• Monitor for any skin changes on the toes or feet and seek medical care promptly.
• Control inflammation with OTC anti-inflammatories.
• Keep feet warm and dry to avoid triggers.
• Avoid constricting socks and footwear.
• Walk gently, avoiding injury, and don't go barefoot.
• Elevate feet to improve circulation.
• Stay well hydrated and eat a balanced diet.

Getting vaccinated and boosted against COVID-19 will also lower your risk by reducing the severity of infection if you do get sick. This protects the immune system, blood vessels, and organs from going into overdrive in response.

Takeaways

• COVID toes refers to painful red, purple or blistering rashes on the toes and feet reported in some COVID-19 patients.
• It seems to affect younger people more often, including children and adolescents.
• Experts think COVID toes arises from inflammation or circulation issues caused by COVID-19.
• While the rash itself is not contagious, it warrants COVID-19 testing and isolation.
• Most COVID toes resolve without treatment in days to weeks.
• In rare cases, the lesions may indicate blood clots or lasting damage requiring urgent care.
• Avoiding COVID-19 infection by distancing and masking is the best way to prevent COVID toes.

COVID toes demonstrate how the COVID-19 virus can have strange ripple effects long after initial infection. While rare and mostly mild, COVID toes illustrate the systemic nature of COVID-19 and the need for continued research. Consult a doctor at the first sign of any unusual skin changes, and take care to avoid infection through safe COVID-19 practices.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.