Pediatricians warned about ‘COVID toes’ in children infected with COVID-19

TORONTO — The Canadian Paediatric Surveillance Program (CPSP) is warning doctors and parents about skin changes on children’s feet or hands as a possible sign of COVID-19 infection.

A public health alert issued to pediatricians identifies the bluish-red and purple lesions — dubbed “COVID toes” — found on the toes and fingers as a possible symptom of COVID-19 infection, predominantly found in children.

While this evidence is not yet backed by peer-reviewed studies, the alert states that children may be otherwise asymptomatic or have mild symptoms in addition to the skin lesions.

The CPSP says the lesions should prompt clinicians to test for the new novel coronavirus. Researchers say the testing is necessary to ensure proper tracking of potential community spread and to initiate self-isolation for patients and anyone who may have come into contact with them.

Dr. Ebbing Lautenbach, chief of infectious disease at the University of Pennsylvania’s School of Medicine, previously told CTVNews.ca that the lesions look similar to pernio or what is commonly referred to as frostbite, and can hurt or feel warm when touched. He said they often occur on the pads of the toes, but can also appear on the upper side of the foot.

Doctors are asked to report all confirmed cases of COVID-19 in a child with skin lesions to the CPSP.

Initial reports about skin problems associated with COVID-19 were first documented in late March by a doctor in Italy who found that 18 of the 88 patients studied (20 per cent) had some kind of skin problem.

In response, the American Academy of Dermatology has asked its members and other physicians around the world to report any dermatological symptoms associated with COVID-19 to a registry so doctors can better understand how COVID-19 affects the skin.

A podiatrists’ association in Spain has also opened a registry to track skin conditions that may be related to the virus. France’s National Union of Dermatologists also issued a notice to its members that the lesions can be a possible sign of infection.

The World Health Organization (WHO) does not list skin problems as known symptoms of COVID-19, but has been watching closely as experts in several countries continue to study the issue.


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