Since the beginning of the pandemic, it has been widely known that fever, cough and breathing difficulties are the most common symptoms of COVID-19. However, with the advent of “COVID toes,” the skin has also been moved to the center of pandemic interest.
Knowledge about the disease is ever evolving as dermatologists all over the world have been gathering data on skin findings.
Many other viral diseases are known to cause a skin rash. Some can be distinctive like measles or chickenpox, while others can present with a multitude of eruptions. COVID-19 appears to be in the second category and preliminary data suggests that up to 1 in 6 affected people will develop a rash. Children are more likely to develop rashes and it might be their only symptom.
So, what exactly are “COVID toes?”
Early on, doctors started to notice swollen, discolored toes and sometimes fingers in patients who tested positive for coronavirus, coining the term “COVID toes.” The color change — which ranges from dark red to purple — can be associated with pain or itching, but for many it does not feel any different.
For most patients, the COVID toes last for up to two weeks, though they may last longer for some people. Treatment for this skin finding is usually not necessary but topical steroids can help with associated itching or pain.
It’s important to note that there’s another skin disease called chilblains that can look just like COVID toes. This condition presents as swollen and discolored fingers and toes after exposure to cold and wet weather.
Other COVID-19 skin and hair symptoms
Rashes, blisters and bruises
Dermatologists have seen many other presentations of a coronavirus infection on their patients including:
- Patchy rashes on the trunk
- Blisters that can look like chickenpox
- Hive-like rashes
- Bruise-like spots
Since masks have become our daily companion, breakouts have increasingly done so too. As the name suggests, “maskne” is acne as a result of wearing your mask and usually presents in areas of occlusion or friction under the mask. For most of us, it is a combination of mild irritant dermatitis and flaring of mild rosacea and acne.
Simple steps that can help reduce this side effect and prevent acne overall are your best friend here, including:
- If you are wearing a cloth mask, make sure to wash it daily.
- If you are wearing disposable masks, try to replace them frequently as most masks will be moist after wearing them for a few hours.
- Wash your face daily with a gentle cleanser to remove make up, dead skin cells and oil, and follow this up with the application of a mild moisturizer.
- Try to avoid harsh anti-acne products since they can cause more irritation.
In addition to skin changes, reports of telogen effluvium — hair loss that often develops several months after an illness or significant life stressors — have been noted in patients with a COVID-19 infection.
Studying COVID-19 skin changes
We are all still learning about COVID-19. We believe that many findings like COVID toes are associated with the infection, but we are not sure exactly what is causing the skin change. For 64 percent of patients, skin changes occurred after experiencing other COVID-19 symptoms. Not all patients who develop a rash or COVID toes will have other symptoms and many will feel completely healthy.
If you do notice COVID toes or other suspicious skin findings, with or without other COVID-19 symptoms, it is recommended to see your doctor for evaluation and possible testing. Even though skin findings are usually not of serious concern, they could be a sign of more worrisome issues.
We are also learning more and more about possible inflammation-related findings. For example, preliminary data suggests that bruise-like spots could be associated with blood flow issues and could be a sign of blot clots in other organs. At this time, it is also unknown whether patients with only COVID toes or rashes are contagious.
My advice? Continue to be cautious and practice standard precaution measures until you have been evaluated by your doctor.
Keep in mind that this is a new disease and we are still learning a lot about COVID-19 every day. This article might look completely different in a year, but until then, we know that it is important to wear a mask to reduce the spread of the disease.
If you’re struggling with the dermatology impacts of COVID-19, find a dermatologist near you.
About the author
Kirstin Altman, MD, is a dermatologist on the medical staff at Baylor Scott & White Medical Center – Temple.