Red patches on the fingers.
Red patches on the fingers.
Violet-red discoloration and crusting at the tip of the nose.
Violet-red discoloration and crusting at the tip of the nose.
Deep red patches, some crusted, on the fingers.
Deep red patches, some crusted, on the fingers.
Deep red and violet discoloration on the fingers.
Deep red and violet discoloration on the fingers.
Deep red discoloration on the palms and fingers.
Deep red discoloration on the palms and fingers.
Bright red patches, some with blistering, on the foot and toes.
Bright red patches, some with blistering, on the foot and toes.

Images of COVID Toes and Chilblains (6)

Red patches on the fingers.
Violet-red discoloration and crusting at the tip of the nose.
Deep red patches, some crusted, on the fingers.
Deep red and violet discoloration on the fingers.
Deep red discoloration on the palms and fingers.
Bright red patches, some with blistering, on the foot and toes.

COVID Toes and Chilblains

Chilblains, also known as pernio, are painful, swollen papules (small, solid bumps) that appear on exposed skin such as the fingers, nose, or toes in cold, damp weather. A rash called “COVID toes” (pseudo-chilblains), which can occur in coronavirus disease 2019 (COVID-19), is similar in appearance. Like chilblains, it can appear on the fingers as well as the toes.

Who's At Risk?

  • Children, young-to-middle-aged women, people who are underweight or have poor circulation, and people with an autoimmune disease have an increased risk of getting typical chilblains. Wearing clothing that exposes the skin to cold air also increases the likelihood of chilblains.
  • Both children and adults can get COVID toes.

Signs & Symptoms

  • Red or purple, swollen papules appear on the feet and hands, including the toes and fingers. Sometimes the surrounding skin turns purple, or occasionally blue. You may see blisters or scabs. The skin may be tender to the touch and painful. The skin may burn or itch.
  • COVID-19-related lesions of the toes or fingers can appear anytime during the year. It is unclear why COVID toes occur, but people are likely still infectious with COVID-19 at the time. Frequently, COVID toes are the only symptom of COVID-19. The skin changes can last for weeks and will resolve with the illness.
  • Typical chilblains commonly appear in cold, damp weather. Cold weather causes the tiny blood vessels in the fingers, toes, and nose to constrict. When these areas warm up again, the blood vessels open and there is swelling and inflammation. Chilblains following cold exposure last about 1-2 weeks.

Self-Care Guidelines

  • If your child or other family members develop red or purple lesions on their fingers or toes, contact a medical professional about testing for COVID-19.
  • Acetaminophen can help improve pain or tenderness associated with chilblains.
  • Applying moisturizing cream to the affected areas can reduce itching.
  • For chilblains due to cold weather, rewarm the affected areas gently without the use of direct heat.

Treatments

Your child’s medical professional may:

  • Order COVID-19 testing.
  • Do blood tests to check for any underlying medical conditions.
  • Recommend a biopsy (removing a small sample of skin for further evaluation under a microscope) if your diagnosis is in question.
  • Recommend topical corticosteroid cream to help resolve associated inflammation and itch.
  • Recommend medicine that lowers blood pressure that can open the blood vessels and increase blood flow in the case of typical chilblains.
  • Prescribe antibiotics if the skin becomes infected.

Visit Urgency

See a medical professional if:

  • You suspect your child has COVID-19. Call and ask for instructions on how to best seek medical care in your community.
  • Fever, cough, diarrhea, or other flu-like symptoms develop.
  • The skin blisters or breaks down, resulting in open sores.
  • The condition worsens after self-care.
  • You suspect your child has an underlying condition causing the chilblains, such as lupus.

Trusted Links

References

Bolognia J, Schaffer JV, Cerroni L. Dermatology. 4th ed. Philadelphia, PA: Elsevier; 2018.

James WD, Elston D, Treat JR, Rosenbach MA. Andrew’s Diseases of the Skin. 13th ed. Philadelphia, PA: Elsevier; 2019.

Kang S, Amagai M, Bruckner AL, et al. Fitzpatrick’s Dermatology. 9th ed. New York, NY: McGraw-Hill Education; 2019.

Paller A, Mancini A. Paller and Mancini: Hurwitz Clinical Pediatric Dermatology. 6th ed. St. Louis, MO: Elsevier; 2022.

Last modified on July 18th, 2023 at 4:53 pm

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