COVID-19 Special Report

COVID Toe?

Reports of a bizarre toe lesion have been making the rounds as a potential new symptom of the novel coronavirus. These so called ‘COVID toes’ were reported as a potential early sign of infection, especially among children – offering hope that there may be some way to detect the virus in otherwise asymptomatic individuals.

Early data from Spain, published by Dr. Isabel Colmenero and colleagues, suggested that these could be arising from the virus infecting and spreading in the skin (rather than the lungs). This could result in anything from a dull looking bruise all the way to a fully inflamed and blistered toe.

It is unclear why the toes may be a potential target for COVID. It’s possible that it simply thrives in the moist environment of a shoe or that slight damage caused by friction during walking may cause tiny abrasions – allowing the virus below the top layers of skin. It’s also unclear what the virus does, once in the toes. Some studies have found that it may enter the blood stream, other that it infects a few cells.

Should we be screening toes as kids walk into the classroom?

Probably not. Only a small fraction of COVID cases have so far been accompanied by these skin anomalies, though there is ongoing research to better understand how the skin responds to COVID-19. There are also many other injuries and illnesses that can cause a toe to be inflamed rather the corona virus – anyone who ever stubbed their toe need not be reminded of this. However, if you do notice an unsual, or inexplicable skin leision, a COVID test for yourself and your household may be a good idea.