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Wednesday, June 03, 2020

Covid toe: Toes show discolouration, but is coronavirus the cause?

Covid toe: Doctors The Indian Express spoke to have not yet found such cases among coronavirus patients.

Written by Mehr Gill | New Delhi | Updated: May 5, 2020 2:13:20 pm
The skin condition causes purple, blue or red discolouration of the toes. (Source: Wikimedia Commons)

So far, the most widely reported symptoms of COVID-19 have been those one would associate with a respiratory infection, such as fever, cough, soreness of the throat. Now, dermatologists have begun to look at skin conditions too. One of the conditions that have emerged has earned itself the description “COVID toe”, with cases reported from Spain and the United States.

Covid toe: What it looks like

The skin condition causes purple, blue or red discolouration of the toes (and sometimes fingers). A study in the International Journal of Dermatology (IJD) has described the condition as chilblain-like lesions. The IJD as well as the British Journal of Dermatology (BJD) have published separate studies detailing such cases in Spain.

In the United States, images of the condition are popping up all over the country, dermatologist Dr Amy Paller said in a statement released by Northwestern University. These images are being collected as part of a US national paediatric dermatology registry.

The BJD study looked at “unexplained” skin manifestations in 375 patients, including confirmed and suspected COVID-19 cases. They described five patterns of skin conditions; among these, COVID toe was observed in 19% (71 of 375). And among these 71 cases, 29 (41%) had confirmed infection with SARS-CoV2.

Is there a COVID link?

That is a hypothesis, as of now, but scientists have called for more evidence. “Our hypothesis is that these lesions could be a late manifestation of COVID-19. This theory is based on the fact that the lesions appeared weeks after reaching the peak of infections in Spain but not at the beginning so far as we are aware,” researchers wrote in the IJD.

In the study in the BJD, the researchers said the lesions could be associated with the disease, but also noted these lesions appear later in the evolution of the disease and are “less commonly associated with virologic confirmation”, so it is possible that the condition may not be related to COVID-19 at all.

Dr Paller of Northwestern Medicine, an initiative affiliated to Northwestern University, said in the statement that she has seen images of approximately 30 cases of this condition. She said more testing is needed to definitely know what is causing the condition.

Covid toe: Is it in India?

Doctors The Indian Express spoke to have not yet found such cases among COVID-19 patients. “We haven’t seen such manifestation in 50 cases we have treated. We are observing blood clots and pulmonary embolism more often now. Some have neurological manifestations,” said infectious disease expert Dr Tanu Singhal.

Dr Pravin Amle, another infectious disease expert, said in Mumbai, “We have come across literature on COVID toe in the West, but it seems to be very rare. We haven’t come across such a case in Mumbai.”

Inputs from ENS, Mumbai

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