What we know and understand about COVID-19 is evolving rapidly and changing every day.  For doctors and patients alike, it is important to stay informed on breaking treatment options, as well as symptoms that can help with the fight against this disease.  Aside from proper protective equipment and medical supplies like ventilators, the most important resource in the fight against COVID-19 right now is communication.  It is communication that is helping us stay on top of the novel coronavirus, as well as developing our understanding of the best screening and treatment options.

The most typical symptoms of COVID-19 still include fever, dry cough, fatigue, and shortness of breath.  Other possible secondary symptoms that are often overlooked are muscle pain & weakness, diarrhea, nausea, and vomiting.  There is however a new symptom with reports coming out recently across the globe which show the virus affects the hands and feet.  These lesions seem to resemble other viral lesions typical of chickenpox, measles, or vasculitis.  Many of us have had or seen these types of skin lesions in our lifetime.  The lesions have been described as purple-colored lesions most common on the toes as well as the soles of the foot and heel.

One of the earliest case studies was published by the International Federation of Podiatrists (IFP) which describes a 13-year-old boy in Italy with purple skin lesions to the foot.  These lesions included blisters and necrosis or gangrenous changes which ulcerated and were painful.  2 days later the boy presented with a fever of 101.3 degrees and began to experience muscle pain, itching, and burning to the skin lesions.  It was later found that the boy lived in a household with his mother and sister experiencing COVID-19 symptoms.  The lesions all ultimately resolved after a few weeks.

Another study by the same authors in the European Journal of Pediatric Dermatology describes several case studies of similar foot lesions that present in, mostly healthy children and adolescent patients with no symptoms prior to developing the skin lesions.  These lesions were found on the hands and feet, but the foot lesions were most severe causing pain, blistering, ulceration, and necrosis.  This study showed mostly resolution of the lesions within 12-20 days without complication.

It is worth noting that these reports are all still anecdotal, and no large-scale study has come out as of yet with good high-level evidence.  This means there is still much that we don’t know about the skin lesions related to this new virus.  There are multiple registries that have recently been started which can compile evidence from physicians all over the world.  These registries are important tools used to assess patterns and guide future treatment and research opportunities which can help to turn the tide against the virus.

My take-away from this new information is that we should all be on the lookout for these types of skin symptoms which are most common in children.  If you notice these types of lesions it is important to call your local podiatric specialist immediately because COVID-19 like symptoms can begin in as little as 2 days after the skin lesions appear.  It may be prudent to have the child undergo close monitoring to see if other symptoms develop or be tested for the virus if COVID-like symptoms begin.  The good news is that reports show that most of these lesions resolve without complication in just a few weeks.  Foot lesions occur in a small percentage of COVID-19 cases, with the exact number unknown at this time.  The lesions may represent an early warning sign of a possible COVID-19 infection to hopefully allow us to stay ahead of the disease.

Dr. Peter Lovato is a Podiatric Physician & Surgeon with Northern Illinois Foot & Ankle Specialists.  He is also on the board of directors of the Illinois Podiatric Medical Association.