Covid toes could take 150 days, new research

A new analysis shows that long-distance Covid-19 patients may experience prolonged skin symptoms. One patient reports that he has “Covid toes” for almost six months.

The analysis was performed on patients listed on the International COVID-19 Dermatology Registry, the world’s largest registry of coronavirus patients with dermatological symptoms. Almost 1,000 cases have been registered from patients in 39 countries.

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While most dermatological symptoms lasted an average of 12 days, some patients reported longer periods.

“When we looked at symptom duration, some of these patients really had incredibly long-lasting symptoms,” said Dr. Esther Freeman, the registry’s principal researcher and director of global health dermatology at Massachusetts General Hospital in Boston. “In particular, we have seen this in chilblains, also known as Covid toes, where they have had skin symptoms for more than 60 days.”

Two patients had much longer times: one patient had Covid toes for over 130 days and another had them for over 150 days.

“You have had toe swelling, discoloration, and toe pain for many months,” Freeman said. “They had this really persistent inflammation.” And unfortunately, there is not much doctors can do for these patients. There is currently no known treatment for Covid toes, Freeman said.

Other skin symptoms include hives, which in most cases lasted about five days, and scaly papules and plaques called “papulosquamous eruptions,” which lasted about 20 days. Several symptoms can indicate the severity of Covid-19 infections: Freeman said that only about 16 percent of patients with Covid toes were hospitalized, while 100 percent of patients with a condition known as retiform purpura (a rapidly spreading red or purple rash) in a web-like pattern) were hospitalized.

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Freeman said that while the registry primarily tracked dermatological symptoms, it also tracked other symptoms experienced in people with confirmed coronavirus cases. Some with long-lasting skin symptoms also reported other symptoms such as cough and persistent fatigue. Outside of the registry, there have been a variety of long-distance symptoms attributed to COVID-19, including heart damage, lung scars, kidney abnormalities, hair loss, mental health problems, insomnia, and neurological symptoms.

The analysis, which will be discussed at the 29th Congress of the European Academy of Dermatology and Venereology, could have implications for understanding other persistent symptoms in long-haul COVID-19, Freeman said.

“These data expand our knowledge of how Covid-19 can affect several different organ systems, even after patients have recovered from their acute infection,” Freeman said in a press release. “The skin can provide a visual window for inflammation that can occur elsewhere in the body.”

While some of the long-lasting symptoms may sound scary, Freeman emphasized that they only occurred in a small number of patients and did not appear to pose a significant health risk.

“(Covid toes) go away relatively quickly, and they go away on their own, and they don’t seem to have much long-lasting effects,” she said. “I don’t want people to panic. I think it’s important to be reassured that this is linked to a fairly mild illness in general … it’s just important to realize that there is a subset of patients who seem to have these really long lasting symptoms and that is a group that we need to understand better. “

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