Kyle A. Habet, MD.
Editor: Alysa Berbey, MM, MAT
Skin Findings and “COVID toes”
Rashes are very common in many viral illnesses like measles and chickenpox.1 The question is: Are there any dermatologic manifestations in COVID-19? In one report, about 20% of patients had some form of skin finding including erythematous rash (red rash), urticaria (hives), and “chicken pox-like” vesicles.2 In another report, COVID-19 was misdiagnosed initially for Dengue Fever because the initial presentation was fever, petechial rash (see figure 1), and low platelets. This patient was later diagnosed with COVID-19 in a tertiary level institution as respiratory problems developed.3 There have been reports of dermatologic findings on the feet sometimes referred to as “COVID toes” which are frostbite-appearing lesions that may vary in presentation that appear on the toes.4,5 In light of the evidence, there seems to be an association with COVID-19 and skin manifestations. An international registry is currently being assembled by the American Academy of Dermatology to document skin findings associated with COVID-19.6
Cardiovascular Symptoms and Strokes
COVID-19 is thought to infect host cells through receptors in the lungs, while also causing damage to the heart, although the specific mechanisms are uncertain. Patients with underlying cardiovascular disease and COVID-19 infection have a worse prognosis.7 One study reported strokes as the initial presenting symptom of COVID-19. The patients were under the age of 50 and had little to no symptoms but tested positive for COVID-19 upon admission.8 The reason for this is unclear but it has been proposed that COVID-19 may cause inflammation of blood vessels and clot formation.9
1. Scott LA, Stone MS. Viral exanthems. Dermatol Online J. 2003;9(3). https://escholarship.org/uc/item/3wd095bt. Accessed May 1, 2020.
2. Recalcati S. Cutaneous manifestations in COVID-19: a first perspective. J Eur Acad Dermatol Venereol. n/a(n/a). doi:10.1111/jdv.16387
3. Joob B, Wiwanitkit V. COVID-19 can present with a rash and be mistaken for dengue. J Am Acad Dermatol. 2020;82(5):e177. doi:10.1016/j.jaad.2020.03.036
4. Coronavirus (COVID-19) infection–induced chilblains: A case report with histopathologic findings – JAAD Case Reports. https://www.jaadcasereports.org/article/S2352-5126(20)30282-4/fulltext. Accessed May 1, 2020.
5. Ariana EC. ‘Frostbite’ toes and other peculiar rashes may be signs of hidden coronavirus infection, especially in the young. Washington Post. https://www.washingtonpost.com/health/2020/04/29/coronavirus-rashes-toes/. Accessed May 1, 2020.
6. COVID-19 dermatology registry. https://www.aad.org/member/practice/coronavirus/registry. Accessed May 1, 2020.
7. Zheng Y-Y, Ma Y-T, Zhang J-Y, Xie X. COVID-19 and the cardiovascular system. Nat Rev Cardiol. March 2020:1-2. doi:10.1038/s41569-020-0360-5
8. Oxley TJ, Mocco J, Majidi S, et al. Large-Vessel Stroke as a Presenting Feature of Covid-19 in the Young. N Engl J Med. 2020;0(0):e60. doi:10.1056/NEJMc2009787
9. Klok FA, Kruip MJHA, van der Meer NJM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. April 2020:S0049384820301201. doi:10.1016/j.thromres.2020.04.013