Anecdotal reports are emerging of patients with COVID-19 presenting with purplish patches on their toes. Sometimes, these findings are the only sign of otherwise asymptomatic COVID-19, and sometimes they are the initial presenting sign in advance of fever and upper respiratory symptoms. These skin findings (more details here and here) look remarkably similar to pernio (chilblains):
|Purple discoloration of "COVID toes" (source)|
None of these "COVID toes" reports have been formally published yet, but the American Academy of Dermatology has a registry to report skin manifestations of COVID-19. Family physicians presented with a chief complaint of skin changes in the feet or hands may wish to consider COVID-19 infection on their differential. We still have much to learn about SARS-CoV-2, and no organ system seems to have been spared across the spectrum of patients with COVID-19 illness. As our collective understanding continues to evolve, you can access a wealth of COVID-19 resources at the top of the AFP website, including research briefs, published articles from FPM and the Annals of Family Medicine, and AAFP CME opportunities.