Coronavirus and Skin: Covid Toes
Here at First Derm we’re doing everything we can to bring you the latest news on Covid-19 in dermatology. There has been some updates since we last wrote about our coronavirus appearing on the skin findings. Although some of the recent studies show elevated cases of Urticaria, Rosacea and more. One skin condition has a clearer connection to coronavirus than any other. This is the phenomenon known as ‘Covid toes’ – namely, a form of chilblains in the toes. Lets dive into what this all means…
What Is Covid Toes?
The name was coined by many news outlets to describe a strange skin conditions that is appearing more frequently in those who have contracted Covid-19. Described as Covid toes, it is a form of chilblains usually affecting, you guessed it: the toes. The toes swell, can become dark blue, are usually painful and sometimes itchy. It is caused by an inflammation of small blood vessels in the skin. Typically, this condition is caused by prolonged exposure to cold but not freezing weather.
The understanding is that chilblains are caused by an abnormal reaction in the body when exposed to cold weather which is then followed by rewarming. Small blood vessels are then prone to expanding more quickly than nearby, larger blood vessels. It is believed that this causes a kind of bottleneck leading to blood leaking into nearby tissue.
Chilblains and Covid-19 – How Strong Is The Connection?
Since this condition usually appears due to changes in the weather, it was flagged by several dermatologists due to an increase in recent cases. The leading research so far is from an ICU in the Netherlands. Of 184 patients suffering from Covid-19 induced pneumonia, 31% had complications related to blood clots (known as thrombosis).
These blood clots would explain some of the more severe complications connected to Covid-19. As an example, blood clots can break apart and land in the lungs, blocking vital arteries – this is known as a pulmonary embolism. These clots can also lodge in the brain and cause a stroke.
Columbia university medical center have also been analyzing this study in the Netherlands. They stated that many of these Covid-19 patients have much higher levels of D-dimer which is a byproduct of blood clots. Their research concludes that the likelihood there is a connection between blood clots, Covid-19 and mortality is high.
What about other skin conditions?
There are a number of other skin conditions associated with coronavirus. In fact, you can find a huge collection in this research. The reason this wasn’t highlighted is because the strongest evidence at present, is for the Covid Toes condition. Although conditions such as Urticaria, Rosacea, Dermatitis and even Acne have been appearing there could be several reasons for this.
Namely, these conditions could have been caused by a reaction to any drugs and medication the patient is taking – this is most likely to be linked to the increased cases of urticaria (hives). For dermatitis and acne, this could be caused by elevated levels of stress, changes to skin care routines, frequent hand washing and wearing protective masks. Although they are all associated with Coronavirus, none of these diseases can safely claim to be caused by the virus at this stage.
There are two Spanish studies by the Spanish Academy of Dermatology that address these conditions. Here you can find the first article and second article related to these skin conditions and Covid-19.
Conclusion on Covid Toes
After assessing the research, at this stage the most clear example of Covid-19 appearing on the skin is in chilblains. Many other conditions could be explained by other factors and there are too many variables to make a clear call. With that in mind, we would recommend anyone who believes they are suffering from chilblains to get checked by our online dermatologists. If confirmed, use our dermatologist recommendation to get a Coronavirus test as quickly as possible and in the meantime follow WHO or your government’s health advice (USA: CDC, UK: NHS) on Covid-19.
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Specialist doctor from the University Hospital in Gothenburg, alumnus UC Berkeley. My doctoral dissertation is about Digital Health and I have published 5 scientific articles in teledermatology and artificial intelligence.