COVID-19 gripping the entire globe, affecting cornucopia of people irrespective of their caste, creed, colour, sex, and religion, has now become a baffling viral disease with a laundry list of clinical signs and symptoms. Knowing the fact, that coronavirus affects mainly our respiratory, gastrointestinal, and sometimes nervous system; it is nowadays trouncing our skin too which is vindicated by few dermatological findings that have been described so far.
Musing over the viruses, their dermal effects are very well established, causing a variety of diverse viral rashes and eruptions. It was indeed not out of the ordinary for any of us to assume there may be some viral rashes that we would finish up seeing with COVID-19 as we see with many other viruses.
So, one of the conditions that have emerged and popped up all over social media has gained itself the description as “COVID toe”, with cases reported in Spanish and American people. What it looks like, is itself a mystifying clinical phenomenon and this skin condition causes purple, blue, or red discoloration of the toes mainly and sometimes on fingers.
These dermatological manifestations were recently supported and published in the ‘International Journal of Dermatology’ (IJD) as well as the British Journal of Dermatology (BJD). The study published in the ‘International Journal of Dermatology’ (IJD) highlighted the pattern of skin manifestation resembling the chilblains or pernio and it is thought to be a cutaneous manifestation of COVID 19 and perhaps its introductory symptom, but a fever and dry cough may be trifling or even absent.
The doctors described multiple skin lesions especially on the toes, soles, fingers, extremities, and heels and it seems to go away after about 2-3 weeks. The COVID toe patients of different age groups were mainly reported asymptomatic but fewer patients revealed cough, fever, or congestion 3-4 weeks before and some had risky contacts and some patients had positive test weeks before.
Likewise, the ‘BJD’ study explored unexplained skin manifestations in 375 patients, including confirmed and suspected COVID-19 cases. Their results described five patterns of skin conditions and COVID toe was observed in 19% (71 of 375) patients and among these 71 cases, 29 patients had confirmed infection with COVID-19.
On the whole, the COVID toe symptoms were mostly seen in young and relatively healthier patients (children and adults). It is fascinating that skin lesions have also been described in animals chiefly in cats having coronavirus infections and such lesions are more frequent in young animals and during the late stages of the disease.
COVID toe and COVID-19, is there a COVID link? To answer this question the doctors and scientists are burning the midnight oil to hunt for the pathological dynamics of COVID 19 and regarding ‘COVID-toe’ by now it’s a hypothesis but scientists have called for more indicia.
The hypothesis is that these skin lesions could be a late manifestation of COVID-19 and this theory is based on the fact that the lesions emerged weeks after reaching the peak of infections in Spain but not at the beginning so far.
Authors from the ‘International Journal of Dermatology’ (IJD) hypothesized that it could be an antigen-antibody immunological processes at a time when the viral load and infectivity are low.
Unfortunately, at present scientists not had the opportunity to biopsy to verify whether these lesions are vasculitis or vasculopathy, microthrombi occlusion, cutaneous polyarteritis nodosa (PAN), or chilblain-like lupus.
Keeping in view these facts, and facing such types of lesions, the researchers are proposing to develop and explore possible contacts with COVID-19, and in every case inquire about the existence of fever or cold in the weeks before the appearance of the skin lesions.
Equally, these lesions could help in the diagnosis of otherwise asymptomatic patients. Furthermore, the scientists are stressing upon performing the reverse transcription-polymerase chain reaction (RT-PCR) test and IgM -IgG serological test that will be of great interest to study skin manifestation in such patients.
Until further confirmation that these lesions are related to COVID-19, it’s an obligation for doctors, and researchers to be cautious and recommend general measures of social distancing, hygiene, self-isolation, and surveillance.
Based on these studies, it seems that some people may develop these lesions while they are still infectious, while others may develop them somewhat later in the disease course.
Therefore, there is a dire need for more data on the timing of these pernio-like lesions for better guidance and counselling of the patients.
Concluding with these lines; it’s a duty of all us not to rush to the emergency section if you find your toes or fingers in an irregular topography. So if you find such a thing, the first option that must click your mind is telemedicine.
After a proper Telemedicine consultation, it’s the doctor who will decide whether to stay inside the home or visit the hospital for testing. So, don’t panic, just trust your doctors.
Author is Ph.D. Scholar, Dept. of Medicine F.V.Sc & A.H, SKUAST-K