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COVID toes: where do we stand with the current evidence?
1Department of Dermatology, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Avenue Hippocrate 10, 1200, Brussels, Belgium.
COVID toes, or chilblains, were frequently seen during the pandemic, but direct links to SARS-CoV-2 infection remain unconfirmed. Lifestyle changes during lockdown may be a more likely cause for these skin lesions.
Area of Science:
- Dermatology
- Infectious Diseases
- Immunology
Background:
- Increased incidence of chilblain-like lesions, termed
- COVID toes
- observed in young individuals during the COVID-19 pandemic.
- Pathophysiology and direct association with SARS-CoV-2 remain debated.
Purpose of the Study:
- Investigate the unresolved questions surrounding COVID toes.
- Determine the association between chilblain lesions and COVID-19.
Main Methods:
- Review of clinical observations and diagnostic tests.
- Analysis of temporal correlation with the COVID-19 pandemic.
- Evaluation of immunostaining, RT-PCR, and serology results.
Main Results:
- While a temporal link exists, direct evidence for SARS-CoV-2 in chilblains is weak.
- Immunostaining shows low specificity; RT-PCR and serology are predominantly negative.
- A strong type I interferon response is hypothesized, but not definitively proven.
Conclusions:
- A direct causal link between chilblains and COVID-19 is currently unconfirmed.
- Indirect factors, such as lifestyle changes during lockdown, are a plausible explanation.
- Further systematic studies with robust follow-up are needed to clarify the association.
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