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Skin Manifestations of COVID?

May 7, 2020


This is a tricky disease. I recall talking to my dermatologist friend in late February/March, so like 6-7 years ago in COVID time, and he mentioned there weren’t any skin manifestations of COVID but there was an interesting derm drug that may be promising. He was the first person to point out the potential use of hydroxychloroquine, an old malaria drug that has a lot of uses in modern-day dermatology. By the way, I’m going to write a “for dummies” on the different types of studies there are in medicine and why we need Randomized Controlled Trials to answer questions on the effectiveness of treatments in medicine (and COVID specifically). 

But I digress, so in the last several months we have learned a ton. It’s unfortunate, but we have a lot of study subjects in the US (over 1 million). While hydroxychloroquine may or may not prove to be beneficial, we now know there are dermatologic, neurologic, renal, hematologic, cardiac, and immunologic, manifestations of COVID just to name a few. 

So I asked this wicked smart board-certified dermatologist to break down a newly learned dermatologic manifestation of COVID called… COVID Toes. Now, I’m not bringing this up as an extra thing to worry about. COVID Toes is uncommon, but it’s a great example of if you give the medical community more time they will have more answers to all these questions. So without further ado, a few paragraphs for the non-medical amongst us…

Many viral diseases cause problems with the skin, common examples include measles, chicken pox, shingles, and mononucleosis (mono). When COVID-19 was first discovered, dermatologists began looking to see if any telltale rashes occurred when people are infected with coronavirus. It is much too early in our understanding of this disease to know for sure or to know all of the possible skin changes COVID might cause.

In the last few months, dermatologists began seeing a striking increase in pernio (also sometimes called chilblains), which is tender, purple bumps on the fingers or toes, usually in response to cold.https://dermnetnz.org/topics/chilblains/This condition is traditionally uncommon and occurs in the elderly associated with diseases like rheumatoid arthritis or lupus.

The term "COVID toes" has been coined to describe pernio in the setting of coronavirus. It has been seen in children and young adults with no other symptoms (like fever or cough) who have tested positive for COVID. Some doctors suspect that COVID could affect blood clotting or damage small blood vessels, which could be the cause as well as explain the increase in more serious conditions like strokes.

If you or a loved one experiences red or purple painful bumps on the hands or feet, it would be sensible to contact your board-certified dermatologist (telemedicine is widely available now) for evaluation and discussion of COVID testing and isolation.

If anyone knows any other specialist that would like to write a paragraph or two about COVID manifestations for the non-medical, send them my way. 

In the meantime…

Stay emotionally connect and physically distant,


PS: I’ve been catching up on a bunch of 2 Guys on Your Head lately and here they riff on the definition of hysteria. If you don’t know 2 Guys on Your Head, they are two UT profs that reflect in quick 10 min episodes on what the social sciences say about different super interesting topics.

PPS: There have been a number of conspiratory stories floating around lately that have been forwarded to me. I'm not really attracted to that type of stuff other than as a spectator to watch the mental gymnastics that folks will go through to maintain the thread. But, I did find this article fascinating. It looked at some of the social science behind why people are attracted to conspiratory theories.