Covid toe (toes)

Chilblain-like lesions or 'COVID toes' are acral lesions described as erythematous to purple purpuric macules, papules, and/or vesicles that predominantly involve the feet, and to a lesser extent, the hands (1).

Histologically, chilblains is an inflammatory disorder showing dermal oedema along with a superficial and deep perivascular lymphocytic infiltrate (2).

Cases of acral lesions resembling chilblains have been reported worldwide at a higher rate than before the pandemic, becoming one of the most commonly reported cutaneous manifestations during the pandemic (1).

It is hypothesised that a robust antiviral immune response in young patients may truncate the clinical course and induce microangiopathic changes that could lead to chilblain-like skin lesions.

• Patients present with chilblain-like lesions only after a successful viral response is mounted and lesions are detected only when symptoms are likely to be subsiding (2).

Click here further information and images of "COVID" toes.

Reference:

1. Discepolo V, et. al. Bilateral Chilblain-like Lesions of the Toes Characterized by Microvascular Remodeling in Adolescents During the COVID-19 Pandemic. JAMA Netw Open. 2021 Jun 1;4(6):e2111369. doi: 10.1001/jamanetworkopen.2021.11369. PMID: 34110396; PMCID: PMC8193438.
2. Massey PR, Krystal MJ. Going viral: A brief history of Chilblain-like skin lesions (“COVID toes”) amidst the COVID-19 pandemic. Semin Oncol 2020 May 23.