While COVID-19 can manifest differently in every person (the most detrimental way being how it affects the lungs), doctors are also learning that the novel coronavirus is affecting some patients by way of mysterious skin conditions. And who the majority of these people are being affected by the skin phenomena may come as a surprise.
One New York dermatologist, Doris Day, M.D., recently reported a wide array of findings, including some manifestations of stress reactions to skin, like acne flare-ups, hair shedding, and hives. But the most interesting manifestations, Dr. Day observes, are rashes that look like chickenpox and a viral rash that causes an almost violet color change in the skin on the toes. This new condition is being dubbed “COVID Toes,” although it’s also being seen on some patients’ fingertips as well.
Dr. Day reiterated that data is still being actively collected on patients who test positive for COVID-19 and are experiencing these strange skin conditions. But she points out it has been reported that approximately 20% of patients in Italy who have tested positive for the virus are also experiencing skin anomalies.
Yet another New York dermatologist, Dhaval Bhanusali, M.D., said that while the cause of “COVID Toes” is not yet known, there is a hypothesis that the virus can cause a ‘pro-clotting’ state that can lead to small occlusions in the blood vessels, possibly even causing the blood itself to become sluggish. When this occurs, it would first be noticed in the outer extremities, like the toes.
Drs. Bhanusali and Day both note that one of the most interesting facets about “COVID Toes” and some types of rashes in COVID-19 patients is that they seem to be occurring mostly in younger people and children, many of whom have little to none of the general symptoms of the virus.
But both doctors, as well as other experts, agree that the good news is the majority of these skin conditions observed at this stage of the pandemic seem to be resolved in a few weeks, often without treatment, and seemingly with no lingering damage to the skin.
Local doctors are weighing in on the recent findings as well. Dermatologist Jill C. Fichtel, M.D., of Transformative Dermatology in Franklin, TN shared her professional view on the phenomenon of “COVID Toes.”
“My thought on the skin findings are that they are a reactive, outward sign of the body’s hyperstimulated state as a result of the virus, similar to the sandpaper rash of strep throat or rashes of other viruses like measles,” Dr. Fichtel said. “The skin findings aren’t a problem in and of themselves, are likely asymptomatic, and will resolve without consequence or treatment as the body heals itself of the virus.”
Dr. Fichtel went on to explain the related anatomy of the condition to shed a little more light on how it manifests.
“‘COVID Toes’ are likely a result of the inflammatory process in the small vessels of the extremities, similar to when the tiny blood vessels constrict as the result of cold, damp weather,” she explains. “The outward skin manifestation and the mechanism (constricted blood flow) is basically the same, although the process is slightly different. This constriction and resulting inflammation, in either case, can cause some discomfort or itching in the skin. This may be helped with topical steroids or lidocaine as a symptomatic relief. But in the case of the virus, it should resolve once the body heals and the hyper-stimulated state is alleviated.”
If you think you are experiencing any of these skin conditions, it’s important to consult with a properly trained, board-certified dermatologist, like Dr. Fichtel, to provide an accurate diagnosis.
In the meantime, the American Academy of Dermatology has established a registry for physicians to report their individual findings. This is in the hope to have more detailed information on the COVID-19-related skin conditions in the very near future.