Going viral: A brief history of Chilblain-like skin lesions (“COVID toes”) amidst the COVID-19 pandemic

Pediatric COVID toes and fingers

“… 16 Ages ranged between 8 – 19 years, excluding one 54-year-old patient, and consisted of 11 girls and 22 boys. The lesions were described as “circumscribed erythematous edematous elements with a purplish red color” and appeared most often on the feet (29), followed by the hands, 5 and rarely on the face. 2 Most patients had no local symptoms (19/33), and the most common complaint was swelling (9 cases), followed by itching, 8 pain, 6 and burning.…”

“… 22 Chilblains associated with systemic diseases, including autoimmune conditions, connective tissue diseases, hematologic malignancies, and Epstein-Barr Virus, is termed secondary pernio, and usually develops in older patients. 5 Pernio classically presents as erythematous or violaceous papules on the toes and fingers bilaterally, sometimes with blistering or ulceration ( Fig. 1 ).…”

“…Given the increase in chilblain-like cases in the springtime and the temporal association with the spreading pandemic, it likely related to COVID-19 infection. 5 …”

New-onset chilblains in close temporal association to mRNA-1273 vaccination

“…Since the beginning of the COVID-19 pandemic, chilblain-like lesions have been observed in adults with severe disease and in asymptomatic or mildly symptomatic younger patients. 2 , 3 The hypothesis of a robust antiviral type I interferon response in younger patients leading to early viremia clearance has been inconclusive, since few patients were tested for SARS-CoV-2 by reverse-transcriptase polymerase chain reaction and serology in the early reports. 1 , 2 , 3 Now with greater availability of resources, researchers are testing larger sample sizes and at different stages of the disease.…”

Atypical cutaneous and musculoskeletal manifestation of SARS-CoV-2: ‘COVID-19 toes’ and spasticity in a 48-year-old woman

“… 7 The current literature reports that this symptom of COVID-19 occurs predominantly in children and young adults later in their disease course. 8 We present a case of ‘COVID-19 toes’ in a 48-year-old woman with underlying coagulopathic syndrome.…”