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COVID toes, rashes: How the coronavirus can affect your skin


If you develop a rash, tell your doctor

A rash may be a sign of COVID-19. A rash can also be a sign of another disease.

Telemedicine doctor’s appointment

If you’re on the lookout for symptoms of COVID-19, you’re likely watching for a dry cough, fever, and shortness of breath. You may also want to check your skin.

While less common, the coronavirus can affect your skin. For some people, this may be the only sign of a coronavirus infection.

Here’s what we know so far about how the coronavirus may affect the skin.

COVID toes can develop at any age

Doctors around the world have noticed that some patients who test positive for the coronavirus develop discolored and swollen toes.

Patient with COVID toes
Patient with COVID toes
COVID toes: One or more toes may swell and turn pink, red, or a purplish color.

Here’s what dermatologists are seeing.

While COVID toes can appear at any age, children, teenagers, and young adults seem most likely to develop this condition. These young patients are healthy. Many never develop other, more common symptoms of COVID-19, such as a dry cough, fever, and muscle aches. When they do have symptoms of COVID-19, the symptoms tend to be mild.

What you may see with COVID toes: The condition may develop on your toes, fingers, or both. From what we know, it seems that most people develop this only on their toes, which explains the name “COVID toes.”

The swelling and discoloration can begin on one or several toes or fingers, according to Amy Paller, MD, FAAD, who is a board-certified pediatric dermatologist and Chair of Dermatology at Northwestern Feinberg School of Medicine. At first, you might see a bright red color that gradually turns to purple. COVID toes can also begin with a purplish color.

Patient with COVID toes
Patient with COVID toes
COVID toes: One or more toes may swell and turn pink, red, or a purplish color.

Symptoms: Many people don’t feel anything and only realize that they have COVID toes when they see the discoloration and swelling on their feet (or hands).

Along with the swelling and discoloration, COVID toes can also cause blisters, itch, or pain. Some people develop painful raised bumps or areas of rough skin.

Others may see a small amount of pus under their skin.

Sometimes, people who have COVID toes have other symptoms of COVID-19.

Treatment for COVID toes: To reduce pain or itching, apply a hydrocortisone cream to the affected area. If this fails to bring relief or symptoms worsen, contact a board-certified dermatologist.

How long COVID toes last: While COVID toes go away without treatment, it’s still too soon to know how long most people have the condition. Dr. Paller says it can last 10 to 14 days. Some patients have COVID toes for months.

In children and teens, the coronavirus can also lead to a rare, serious, and sometimes life-threatening condition called Multisystem Inflammatory Syndrome in Children (MIS-C).

Mother taking sick child's temperature

Are COVID toes contagious?

Much remains unknown about the coronavirus, including whether you’re contagious when you have COVID toes. If you have any symptoms of COVID-19, contact your doctor. Explain what’s happening and ask if you need testing.

Condition that COVID toes can look like: Chilblains

If you have swollen, discolored toes or fingers, you may have chilblains instead of COVID toes. Chilblains develops when you’re exposed to cold temperatures. People develop chilblains when they stand on a cool, wet ground and get chilled.

Itchy coronavirus rash
Itchy coronavirus rash
Itchy rash: While in the hospital for COVID-19, this patient developed an itchy rash on both sides of his body.
Chilblains causes the skin on your toes, other parts of your feet, fingers, or other affected areas to burn and itch. Some people see their skin swell and turn red or dark blue. A severe case of chilblains can cause sores or blisters.

Chilblains differs from frostbite, which occurs when the skin freezes.

Coronavirus rash appears in many ways

Many diseases, such as measles and chickenpox, cause a distinctive rash that helps doctors diagnose a patient. COVID-19 is different. There is no single COVID-19 rash.

What you may see: You can have COVID-19 and never develop a rash. When a patient with COVID-19 does develop a rash, it can look like any of the following:

Coronavirus rash looks like hives
Coronavirus rash looks like hives
Hives-like rash: Dermatologists are seeing patients with COVID-19 who develop a rash that looks like hives.

  • Patchy rash

  • Itchy bumps

  • Blisters that look like chickenpox

  • Round, pinpoint spots on the skin

  • Large patch with several smaller ones

  • A lace-like pattern on the skin

  • Flat spots and raised bumps that join together

Symptoms: Some rashes itch.

Treatment: Some rashes require medical treatment.

Coronavirus rash on patient’s leg
Coronavirus rash on patient’s leg
Rash on COVID-19 patient’s thigh: This rash could also be mistaken for hives.

Keep in mind that you can have a rash that’s due to a condition other than COVID-19. If you develop a rash, contact your doctor.

How long does a COVID-19 rash last?

More information is needed to know for sure. Right now, reports suggest that a rash typically lasts between 2 and 12 days, with most people having a rash for 8 days.

Why does COVID-19 only affect some people’s skin?

COVID-19 is a new disease, so doctors are still learning about it. Dermatologists are leading the effort to find out exactly how the coronavirus affects the skin.

Coronavirus rash on patient’s foot
Coronavirus rash on patient’s foot
Measles-like bumps on the foot of a patient with COVID-19: Dermatologists have seen bumps that look like measles on the chest, back, and other areas of patients who have COVID-19.

If you develop a rash or COVID toes, you can help others

If you test positive for the coronavirus and develop a rash or COVID toes, you can help doctors learn more about COVID-19. To help, ask your doctor to submit information to the American Academy of Dermatology’s COVID-19 registry.

Doctors from around the world are encouraged to participate.

Related AAD resources


Images
2-3, 5-8: Images used with permission of Journal of the American Academy of Dermatology and JAAD Case Reports.

  • JAAD Case Rep. 2020;6:489-92.

  • J Am Acad Dermatol. 2020 May 4;S0190-9622(20)30789-1.

  • J Am Acad Dermatol. 2020 Apr 10;S0190-9622(20)30556-9.

  • J Am Acad Dermatol. 2020 Jul;83(1):e61-e63.

1, 4: Getty Images

References
Barry J. “Pediatric dermatologist explains 'COVID toes.’” Dermatology Times, May 20, 2020.

Bosworth T. “Heterogeneity seen in COVID-19 skin manifestations.” Medscape Dermatology. May 5, 2020. Last accessed May 8, 2020.

Bayers S, Shulman ST, et al. “Kawasaki disease: Part I. Diagnosis, clinical features, and pathogenesis.” J Am Acad Dermatol 2013;69:501.e1e11.

de Masson A, Bouaziz JD, et al. “Chilblains are a common cutaneous finding during the COVID-19 pandemic: a retrospective nationwide study from France.” J Am Acad Dermatol. 2020 May 4. doi: 10.1016/j.jaad.2020.04.161. [Epub ahead of print].

Estébanez A, Pérez-Santiago L, et al. “Cutaneous manifestations in COVID-19: A new contribution.” J Eur Acad Dermatol Venereol 2020 Apr 15. doi: 10.1111/jdv.16474. [Epub ahead of print].

Fernandez-Nieto D, Jimenez-Cauhe J, et al. “Characterization of acute acro-ischemic lesions in non-hospitalized patients: a case series of 132 patients during the COVID-19 outbreak.” J Am Acad Dermatol 2020. Apr 24. doi: 10.1016/j.jaad.2020.04.093. [Epub ahead of print].

Freeman EE, McMahon DE, et al. “The AAD COVID-19 Registry: Crowdsourcing dermatology in the age of COVID-19.” J Am Acad Dermatol. 2020 Apr 16. doi: 10.1016/j.jaad.2020.04.045. [Epub ahead of print].

Henry D, Ackerman M, et al. “Urticarial eruption in COVID-19 infection.” J Eur Acad Dermatol Venereol 2020 Apr 15. doi:10.1111/jdv.16472. [Epub ahead of print].

Herman A, Peeters C, et al. “Evaluation of chilblains as a manifestation of the COVID-19 Pandemic. JAMA Dermatol. 2020 Jun 25. doi:10.1001/jamadermatol.2020.2368. [Epub ahead of print].

Hernandez C, Bruckner AL. “Focus on “COVID toes.” JAMA Dermatol. 2020 Jun 25. doi:10.1001/jamadermatol.2020.2062. [Epub ahead of print].

Heymann WR. “The profound dermatological manifestations of COVID-19 – Cutaneous features.” Dermatol World Insights and Inquiries. Vol. 2, No. 16. April 22, 2020. Last accessed May 7, 2020.

Jimenez-Cauhe J, Ortega-Quijano D, et al. “Reply to: COVID-19 can present with a rash and be mistaken for dengue: Petechial rash in a patient with COVID-19 infection.” J Am Acad Dermatol. 2020 Apr 10. doi: 10.1016/j.jaad.2020.04.016. [Epub ahead of print].

Kolivras A, Dehavay F, et al. “Coronavirus (COVID-19) infection-induced chilblains: A case report with histopathologic findings.” JAAD Case Rep. 2020 Apr 18. doi: 10.1016/j.jdcr.2020.04.011. [Epub ahead of print].

Marzano AV, Genovese G, et al. “Varicella-like exanthem as a specific COVID-19-associated skin manifestation: multicenter case series of 22 patients.” J Am Acad Dermatol 2020 Apr 16. doi: 10.1016/j.jaad.2020.04.044. [Epub ahead of print].

Najarian DJ. “Morbilliform exanthem associated with COVID-19.” JAAD Case Rep. 2020 Apr 20. doi: 10.1016/j.jdcr.2020.04.015. [Epub ahead of print].

Ortega-Quijano D, Jimenez-Cauhe J, et al. “Reply to “Varicella-like exanthem as a specific COVID-et al. 19-associated skin manifestation: multicenter case series of 22 patients”: discussing specificity.“ J Am Acad Dermatol 2020 May 4. doi: 10.1016/j.jaad.2020.04.156. [Epub ahead of print].

Quintana-Castanedo L, Feito-Rodríguez M, et al. “Urticarial exanthem as early diagnostic clue for COVID-19 infection,” JAAD Case Rep. 2020 Apr 29. doi: 10.1016/j.jdcr.2020.04.026. [Epub ahead of print].

Rivera-Oyola R, Koschitzky M, et al. “Dermatologic findings in two patients with COVID-19.” JAAD Case Rep. 2020 Apr 28. doi: 10.1016/j.jdcr.2020.04.027. [Epub ahead of print].

Suchonwanit P, Leerunyakul K, et al. “Cutaneous manifestations in COVID-19: Lessons learned from current evidence.” J Am Acad Dermatol. 2020 Apr 24. doi: 10.1016/j.jaad.2020.04.094. [Epub ahead of print].


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