The emergence of the SARS-CoV-2 virus brought with it a wide range of recognizable symptoms, but some individuals developed less common skin manifestations. One such condition, informally termed “Covid Toes,” became a recognized dermatological sign associated with the infection. This condition involves changes to the skin of the extremities, often appearing after the typical respiratory symptoms have passed or even as the only sign of infection. While the exact cause remains under investigation, the physical presentation closely resembles a pre-existing condition known as pernio, or chilblains. This is generally considered a delayed immune response to the viral presence.
Defining the Condition
“Covid Toes” presents as a distinct change in the color and texture of the skin, most often affecting one or more toes, though it can also occur on the fingers. The affected areas typically appear as patches of bright red, purple, or blue discoloration. Swelling is a common feature, often making the digits look puffy or inflamed.
The appearance is consistent with a localized inflammatory reaction, particularly in the small blood vessels near the skin’s surface, a process known as microvascular change. Along with the visible discoloration and swelling, many people experience sensations such as itching, burning, or tenderness when touched. In some instances, the inflammation can be severe enough to cause blisters or painful, firm nodules to form on the affected digits.
Research suggests the underlying mechanism is an intense antiviral immune response mounted by the body against SARS-CoV-2. This response involves the production of high levels of certain immune signaling proteins, which are implicated in causing the inflammation and localized vascular damage. This immune-mediated response links the condition closely to pernio, which is also caused by abnormal reactions in small blood vessels.
Treatment and Management Strategies
Since “Covid Toes” is generally a self-limiting condition, management focuses primarily on alleviating discomfort and preventing complications while the body resolves the inflammation. Home care actions can greatly improve comfort. It is helpful to keep the feet warm, but avoid overly hot baths or direct heat sources, as rapid temperature changes can worsen the inflammation.
Wearing loose-fitting, comfortable footwear and soft socks is advisable to reduce friction and pressure on the swollen areas. Gentle movement of the toes and feet can encourage circulation, which may help reduce swelling. Applying a simple moisturizing cream or lotion can help maintain skin integrity, especially if the lesions are dry or beginning to peel.
For persistent itching or pain, over-the-counter topical treatments are often recommended. A low-strength topical corticosteroid cream, such as hydrocortisone, can be applied directly to the lesions to reduce localized inflammation and itching. If this approach is used, apply the cream sparingly and consult with a pharmacist or physician before starting treatment.
If the discomfort is more widespread or severe, mild over-the-counter pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs), may be taken to help manage pain and tenderness. Preventing secondary infection is another important management step; avoid scratching or picking at the lesions, especially if blisters have formed. If a blister breaks, keep the area clean and protected with a sterile bandage to prevent bacteria from entering the open skin.
Always consult a healthcare provider before beginning any new medication regimen. If the lesions are not responding to simple management strategies, a physician may prescribe a stronger topical corticosteroid or other treatments to help manage the persistent inflammation.
Duration and Medical Consultation
For most individuals, “Covid Toes” is a temporary condition that resolves without the need for extensive medical intervention. The lesions typically clear up on their own within two to four weeks after they first appear. In some cases, the symptoms may be very brief, lasting only ten to fourteen days.
However, some people experience a more persistent form of the condition, with lesions lasting for many weeks or even months; this has been noted as a potential sign of post-acute sequelae of COVID-19, or “Long COVID.” It is recommended to seek medical attention if the lesions fail to show any improvement after three weeks of home care. A visit to a dermatologist or primary care provider is also warranted if the pain or itching becomes severe and is not relieved by over-the-counter creams.
Immediate medical evaluation is required for specific warning signs:
- The appearance of pus, suggesting a secondary bacterial infection.
- Discoloration that darkens significantly or begins to spread further up the foot or leg.
- Any sudden increase in pain.
- Numbness or difficulty walking.