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‘COVID toes’ could be another symptom of coronavirus infection: experts

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Dermatologists around the world are keeping an eye out for possible symptoms of novel coronavirus infection, after reports that in some patients, the disease can affect the skin.

Some are calling the phenomenon “COVID toes” or “COVID hands,” according to Dr. Kerri Purdy, president of the Canadian Dermatology Association.

“They’re these painful red and purple bumps that tend to occur at the tips of the toes or on the tops of the feet, or on the tops of the fingers or tips of the fingers,” she said.

Canadian doctors are accustomed to seeing similar lesions, like chilblains associated with cold weather, she said, but it’s more unusual to see them in warm weather.

“In this particular case, we don’t think it’s related to cold injury,” she said.

“It’s felt to be maybe tiny blockages of the small vessels because we think COVID makes people have increased tendency to blood clots.”

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Other kinds of rashes have been reported in COVID-19 patients too, she said, but it’s too early yet to know how common skin symptoms are with the disease.

“So far in Canada, we haven’t been seeing a ton of it. And I think it may just be that speaking to the fact that our numbers aren’t quite as high as in those other locations,” she said.

Some of the first documentation of skin problems associated with COVID-19 came in a late March report by an Italian doctor, who noted that 18 of 88 patients studied, or 20 per cent, had some kind of skin issue.

The author of the small case report noted that more studies are needed to better understand how COVID-19 affects the skin.

A photo of a blistered toe taken from an Italian case report of a teenager with COVID-19.
A photo of a blistered toe taken from an Italian case report of a teenager with COVID-19. Dr. Francesca Baisi and Dr. Laura D’Aloisio, via International Federation of Podiatrists

Since then, the American Academy of Dermatology has asked its members and other physicians around the world to contribute case reports to a registry of dermatological symptoms associated with COVID-19.

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A dermatologists’ association in France has also issued a bulletin to its members. A podiatrists’ association in Spain has done the same, noting reports of chilblain-like lesions on the feet of children in particular, as well as set up its own registry of foot-related issues to investigate whether they are associated with COVID-19.

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Rashes and other such skin symptoms aren’t terribly unusual with viral infections, said Dr. Julia Carroll, a registered dermatologist practicing in Toronto.

“I think it’s important for people to know that with any viral illness, we do tend to see rashes,” she said. These might be hives, rashes that resemble psoriasis, or come in other forms.

In general, children are more likely to develop rashes as the result of viral infections than adults, Purdy said.

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Carroll believes that it’s far too soon to say whether these symptoms might be a specific effect of coronavirus infection or if they’re a more ordinary reaction to a virus.

“I’d say the jury’s completely out on it right now. I don’t think we’ve had enough time or there’s been enough published that you can link the two together specifically,” she said.

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Scientists searching for answers to frustrating COVID-19 mystery
Scientists searching for answers to frustrating COVID-19 mystery

Purdy believes that while “COVID toes” and other skin issues aren’t a definitive sign of COVID-19, they should be added to the list of possible symptoms.

“I think the chance that this is a possible symptom is quite high,” she said. “I don’t think it’s a very common symptom. But I think only time will tell where the evidence supports that, because you’ll notice that with COVID, things are changing so quickly.”

That doesn’t mean that if you have a rash, you necessarily have COVID-19, though.

“Unexplained rash would be things that you could add to that list, just as something for the general public to consider possibly could be related to COVID-19, but also may not be,” she said.

“But that’s the same for cough, for fever, first runny nose and headache. You know, there’s a bunch of causes of all those things, but I think it would be not unreasonable to add it to the list of things that people might be looking out for.”

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Questions about COVID-19? Here are some things you need to know:

Health officials caution against all international travel. Returning travellers are legally obligated to self-isolate for 14 days, beginning March 26, in case they develop symptoms and to prevent spreading the virus to others. Some provinces and territories have also implemented additional recommendations or enforcement measures to ensure those returning to the area self-isolate.

Symptoms can include fever, cough and difficulty breathing — very similar to a cold or flu. Some people can develop a more severe illness. People most at risk of this include older adults and people with severe chronic medical conditions like heart, lung or kidney disease. If you develop symptoms, contact public health authorities.

To prevent the virus from spreading, experts recommend frequent handwashing and coughing into your sleeve. They also recommend minimizing contact with others, staying home as much as possible and maintaining a distance of two metres from other people if you go out.

For full COVID-19 coverage from Global News, click here.