Are COVID Toes and Rashes Common Symptoms of the Coronavirus?

In the years since COVID-19 made its global debut, our vocabularies have expanded quite a bit. From plays on words like “flurona,” and new diagnoses like long COVID, to complex medical terminology (monoclonal antibodies, anybody?), we’ve become fluent in the language of the pandemic. But now that we’ve been living side-by-side with the virus long enough to gain an understanding of it, it’s time to reassess our glossary.

For instance: COVID toes. Are they really a thing? What about COVID rashes? And do these terms actually describe symptoms of COVID-19? We asked pediatric infectious disease specialist Frank Esper, MD.

If they’re COVID-19-related, they’re uncommon

By now, we’re all familiar with the telltale signs of a COVID-19 infection. But what about the disarming outliers? Should we be concerned?

Dr. Esper says while they’re attention-grabbing and unusual, COVID toes and COVID rashes are quite rare and aren’t signs of life-threatening complications. And while these symptoms have been associated with the coronavirus more than other viral infections, neither of them became widespread during the pandemic.

“These symptoms may be more common in COVID-19 compared with other viral infections,” Dr. Esper continues. “But they don’t affect a majority of people by any means.”

But what if it happens to you? Should you be worried?

Instead of seeing COVID toes or COVID rashes as a sign of danger, Dr. Esper says that we should see them as evidence that our bodies can react to infections in different ways. They may be interesting manifestations of our body’s response to the virus, but they’re nothing to worry about.

Side effects of viral infections

In the early days of the pandemic before home testing was possible, everybody was looking for new signs and symptoms to figure out if they were positive for COVID-19. In that context, COVID toes and COVID rashes seemed novel. But in reality, skin involvement isn’t unusual in the realm of viral infections.

Dr. Esper says it’s actually quite common for people to get rashes when they’re battling infections, especially viral respiratory ones.

“It’s not uncommon for someone to have a viral infection and have a rash or blotchy areas on their body,” he says. “This can happen with measles, for example. And medications sometimes cause skin rashes, too. So, there are a lot of reasons you may get a rash while battling a virus.”

The same goes for the reddish spots or lesions on the feet that we took to calling “COVID toes” in the early days of the pandemic. They aren’t new symptoms. And they can occur for a number of reasons.

“It’s possible that COVID toe is a skin reaction. It could also be caused by a small clog or micro clots in the blood vessels in the toes,” Dr. Esper explains. He’s seen something similar happen with ICU patients with sepsis and people on life support.

It’s a possibility, but it’s not the only explanation out there. In fact, many researchers now think COVID toes have nothing to do with COVID-19.

Could COVID toes actually be chilblains?

There’s a growing body of evidence to suggest that “COVID toe” was never really a thing.

That’s not to say that people’s toes weren’t inflamed or discolored. They were. But many doctors now believe they were just episodes of chilblains — painful patches of skin that occur in response to cold air exposure.

Researchers found a weak correlation between chilblain-style lesions and COVID-19 infection. While they didn’t rule out the possibility of a relationship between chilblains and COVID-19, they offered a few theories as to why incidences of chilblains might have gone up during the early days of the pandemic:

1. People were hyperaware of their bodies because of the pandemic. As a result, they noticed and sought treatment for a condition they might not have noticed otherwise.
2. A lot of people don’t wear shoes and socks when they’re at home … and many of us spent a lot more time at home, thanks to shelter-in-place orders. That could have led to increased cold exposure — and a resulting increase in chilblains.

An article in Nature notes that — as COVID-19 has shifted from an acute crisis into a feature of our daily lives — rates of chilblains have pretty much gone back to normal.

The debate is still alive and well in scientific circles, but for everyday people, it doesn’t especially matter if COVID toes are real. Mercifully, we’re past the stage of the pandemic where we can’t be sure whether or not we’re infected.

When to see a doctor

If you’re concerned that you have COVID toes or a COVID rash, the first thing to do is to see if you have the virus. In countries where they’re available and affordable, most people use home tests to check for COVID-19. And those of us who are vaccinated (and boosted!) are unlikely to experience complications.

If you test positive for the virus, you should isolate at home. If you notice a rash or COVID toes in addition to the more common symptoms of the coronavirus, Dr. Esper says it’s best to contact your healthcare provider. They may prescribe medication to treat your skin and toes. And if your age or health status raises your risk for more severe complications, they may also decide to put you on an anti-viral medication like Paxlovid®.

Toes and rashes aside, you should call 911 or go to the nearest hospital if you have COVID-19 and:

• Are experiencing chest pain, tightness or pressure.
• Are dizzy, lightheaded or experienced a fainting episode (syncope).
• Are struggling to breathe.
• Are exhausted to the point of being unable to stay awake.
• Are experiencing confusion or a sudden change in your mental state.

COVID toe or no, all the basic rules of respiratory virus prevention still apply. If you’re sick, stay home. Wear a mask. When you are out, practice social distancing. And always, always, always wash your hands. Your skin will thank you!