Are "COVID Toes" Real?

Unexplained toe discoloration doesn’t exactly align with the original documented coronavirus (COVID-19) symptoms of fever, dry cough, or shortness of breath. But the unusual number of patients experiencing toe problems during the pandemic has dermatologists speculating that it could be linked to a mild COVID-19 infection.

The phenomenon—which is harmless—has earned a nickname: COVID toes. 

The Centers for Disease Control and Prevention (CDC) does not currently include toe discoloration or toe pain as a potential symptom of COVID-19.

“We’re seeing—one might say an epidemic—of what someone termed ‘COVID toes,’” Amy Paller, MD, chair of the department of dermatology at Northwestern University Feinberg School of Medicine tells Verywell Health. “We don’t yet really understand the relationship to COVID-19. It’s just an observation that we’re making with unprecedented numbers at a time where there’s a pandemic, so we think it may be a sign of mild disease.”

What Are the Symptoms of COVID Toes?

With her patients, Paller has seen something that looks like a skin condition called pernio (also known as chilblains) on the tops of their toes that’s characterized by:

  • Discoloration that’s red, purple, or that progresses from red to purple 
  • Tiny bumps that may or may not be itchy or painful

This photo contains content that some people may find graphic or disturbing.

Potential "COVID Toes"
Potential "COVID Toes". Photo courtesy of Dr. Amy Paller, Northwestern University

Pernio is an inflammatory skin condition caused by over-exposure to cold temperatures. Typically, Paller would expect to see a few patients with pernio in the winter, and the condition usually manifests in the fingers. But the toe-related emails and telehealth visits surged this spring. 

About a third of Paller’s COVID toes patients reported experiencing toe discoloration and no other symptoms. Another third reported experiencing itchiness on the toes in addition to discoloration, and another third said they had toe pain. While Paller has observed that the symptoms usually last for a week or 10 days, some of her patients have had it for months.

Who Is At Risk?

In Paller’s dermatology practice, she’s seen patients of all ages with symptoms of COVID toes. “There are young adults with this, there are older adults with this,” she says. “I’ve seen lots of teenagers. The youngest patient I’ve seen is 7.”  

She suggests that it could be contagious, since she’s treated families and couples who experienced toe symptoms within a short period of time. 

While some of her patients have had cold symptoms, very few have had other symptoms indicative of COVID-19, and very few have been tested for COVID-19 at all.

What's Causing It?

“What I really think it could be is the mild end of the COVID-19 spectrum in individuals who have a brisk immune response,” Paller says. In other words, it’s possible that the person has or had a COVID-19 infection, and red or purple toes is their only symptom. 

“We haven’t been able to firmly connect it to COVID-19 because very few people are getting COVID-19 testing,” she says. In the few instances where the patients with toe issues were able to get tests, they had negative results for the virus.

“Is that just because it’s too late in the disease spectrum by the time it shows up in the toes? Is it that their case is so mild they have a very low viral load and a test just can’t pick it up easily? There are lots of theories out there, but we just don’t know,” she says.

COVID-19 diagnostic tests are still challenging to receive because of a limited supply. High priority is given to people in hospitals or long-term care facilities with symptoms, as well as healthcare workers and first responders with symptoms.

The same uncertainty holds true for immunity. Paller says that even if somebody with COVID toes has a positive antibody test after their symptoms resolve, there’s no proof that those antibodies are protective against another bout of COVID-19.

What Should You Do If You Think You Have COVID Toes?

If you’re experiencing any of the signs of COVID toes, there’s no need to rush to the doctor’s office. Paller says symptoms will resolve on their own.

“We don’t want people putting unnecessary strain on the healthcare system,” Paller says. “For most folks, there’s no urgency here. You can usually take one look at these types of toes and know what’s going on. Get an antibody test down the road if you can, and reach out to your doctor if your toes are really itchy or uncomfortable.”

If your toes are itchy:

Over-the-counter hydrocortisone cream is a good first step. Your doctor may prescribe you a medium-strength topical corticosteroid.

If your toes are painful: 

Consider anti-inflammatories like ibuprofen.

To learn more about how—and if—COVID-19 can manifest as a rash like COVID toes, the American Academy of Dermatology has created a registry for any healthcare provider to log cases of patients with skin symptoms who have either confirmed or presumptive cases of COVID-19. Their findings will be able to help determine how common COVID toes actually are—something nobody knows for sure right now.

What's the Prognosis?

“Everybody does tend to have a pretty satisfactory outcome,” Paller says of her patients. “COVID toes doesn’t damage. There might be a little discoloration at the end, but nobody’s losing toes because of this.”

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  1. Centers for Disease Control and Prevention. Evaluating and testing persons for coronavirus disease 2019 (COVID-19). Updated May 5, 2020.