COVID Toes: What To Know About This Strange Symptom in Kids

COVID toes is a mysterious coronavirus symptom characterized by swollen, discolored toes. But while it may look strange, it's not usually cause for concern in children.

Child Feet COVID Toes
Photo: Getty Images / Ary Dermawan / EyeEm

Two years into the pandemic, experts have uncovered a wide range of COVID-19 symptoms and complications. Perhaps one of the strangest is "COVID toes." Essentially, some people—mainly children and teens—get swollen, reddish toes that may also have itching, pain, or blisters. COVID toes sometimes develop without obvious signs of coronavirus infection, which makes the phenomenon even more mysterious.

So what do COVID toes look like, and how can you treat them? We spoke with two pediatricians to understand more about this symptom in children.

What Do COVID Toes Look Like?

COVID toes are usually reddish/purplish in color, and you may also notice swelling, says Pierrette Mimi Poinsett, M.D., pediatrician and consultant for Mom Loves Best. "Some children may have raised painful bumps or rough skin, [and] the toes may also be itchy." Blisters or pus can form under the skin.

Usually it's just the toes that are affected, explains Dr. Poinsett, but some kids end up having a similar rash on their fingers. COVID toes usually last between 10 and 14 days, but some people continue experiencing the symptom for a few months after infection.

COVID toes often resemble chilblains, which is a rash that's usually associated with exposure to cold temperatures.

Who Develops COVID Toes?

According to the American Academy of Dermatology Association, anyone can get COVID toes, but the symptom is most common in kids, teenagers, and young adults. It's doesn't seem more likely to affect people with underlying health conditions.

Experts are still trying to understand the connection between COVID toes and coronavirus infections. Interestingly, most instances happen after mild or asymptomatic illness—and they've been known to occur even without positive test COVID results, says Molly O'Shea, M.D., pediatrician at Birmingham Pediatrics Wellness Center. The New York Times reports that COVID toes have also appeared "several weeks after the acute phase of an infection is over."

COVID toes can "occur in children who have been exposed (usually in close contact with family members) but never develop symptoms of COVID themselves, never test positive, and never develop immunity (prior to vaccine generated immunity)," Dr. O'Shea explains.

What Causes COVID Toes?

Here's one of the more baffling aspects of COVID toes: there isn't a clear reason for them, explains Dr. Poinsett. "The cause of COVID toes is not completely certain," she says.

One clue may come from an October 2021 study published in the British Journal of Dermatology, which theorized that COVID toes happen as a result of an immune reaction. This study "suggests that COVID toes are due to the body's inflammatory response with the production of Interferon and IgA," Dr. Poinsett explains.

Dr. O'Shea agrees that an inflammatory response is the best explanation we have so far. "COVID toes are inflammatory, meaning that the immune system is responding to something and the tissues of the toes and fingers because they are prone to variable circulation are easy targets," she describes.

How Do You Treat COVID Toes?

COVID toes "aren't worrisome in and of themselves," says Dr. O'Shea. Although their appearance may be off-putting, some children may not be too bothered by them. Others may experience pain, itchiness, and generally irritated skin.

Usually the symptoms resolve in a week or so without treatment. Dr. Poinsett recommends applying some hydrocortisone cream if the toes are itchy. If that doesn't provide relief, you can visit your pediatrician or a dermatologist for further advice; they may advise you to try a stronger prescription skin cream. (But keep in mind that your child might have a contagious COVID-19 infection, so get them tested first.)

What To Do If Your Child Develops COVID Toes

You don't need to panic if your child develops COVID toes. "There are no complications associated solely with COVID toes," says Dr. Poinsett. Still, rashes can signal other COVID-19 complications that may be cause for concern, Dr. Poinsett notes.

For example, some young people get multisystem inflammatory syndrome in children (MIS-C) after a COVID-19 infection, and one telltale sign is a skin rash (other symptoms of MIS-C include fever, tummy pain, vomiting, diarrhea, and bloodshot eyes). It's important to contact your pediatrician as soon as possible if your child develops symptoms of MISC-C. Although MISC-C is a serious condition, with prompt medical attention, it's usually treatable.

Either way, Dr. O'Shea says if your child develops COVID toes, it's important that you contact their health care provider. "All kids with suspected COVID toes should be assessed by their pediatrician to confirm the diagnosis, get tested for COVID to rule it in or out, and figure out if any other cause for the toe rash (like vasculitis due to other immune diseases) is in play," Dr. O'Shea advises.

If you have questions about COVID toes, or COVID-19 in general, don't hesitate to reach out to your pediatrician—that's what they're there for.

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