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 bumps that appear on exposed skin (fingers, nose, 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?

  • Women, people who are underweight or have poor circulation, and people with autoimmune disease have an increased risk of getting typical chilblains. Wearing clothing that exposes your skin to cold air increases the likelihood of chilblains.
  • Both children and adults can have COVID toes.

Signs & Symptoms

  • Red, swollen bumps appear on the feet and hands, including the toes and fingers. Sometimes the skin turns purple or rarely blue. You may see blisters or scabs. Skin can be tender to touch, painful, and red. 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 when they have skin changes of COVID-19. Frequently, COVID toes are the only symptom of COVID-19. Skin changes can last for weeks and will resolve with the illness.
  • Chilblains typically appear in cold, damp weather. Chilblains due to cold weather causes the tiny blood vessels in the fingers, toes, and nose to clamp down. When these areas warm up again, the blood vessels open and there is swelling and inflammation. Chilblains last about 1 or 2 weeks after cold exposure.

Take a picture of your skin condition with Aysa

Symptom checkers like Aysa can help narrow down possible skin conditions by analyzing a skin photo.

Self-Care Guidelines

  • If your child develops red or purple lesions on the fingers or toes, contact your pediatrician about testing for COVID-19.
  • Acetaminophen can be helpful for tenderness. You can apply moisturizing cream to reduce itching.
  • For chilblains due to cold weather, rewarm the affected areas gently without the use of direct heat.
  • Wearing protective gear such as gloves, scarves, and hats can help prevent typical chilblains.
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Treatments

Your doctor may order COVID-19 testing.

  • Your doctor may want to do blood tests for any underlying medical conditions.
  • Your doctor may recommend removing a small piece of skin for further evaluation under a microscope (biopsy) if your diagnosis is in question.
  • Topical corticosteroid cream helps with inflammation.
  • For typical chilblains, medicine that lowers blood pressure can open the blood vessels and increase blood flow.
  • If skin breaks down and becomes infected, antibiotics may be prescribed.

Visit Urgency

  • See a doctor if:
  • You suspect COVID-19 infection. Call your doctor 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.
  • The condition worsens after self-care.
  • You suspect an underlying condition like lupus.
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References

Millard AN, Green CB, Stratman EJ. Cold Injuries. In: Kang S, Amagai M, Bruckner AL, et al, eds. Fitzpatrick’s Dermatology, 9th ed. New York: McGraw-Hill; 2019. 

Smith ML. Environmental and sports-related skin diseases. In: Bolognia JL, Schaffer JV, Cerroni L, eds. Dermatology. Philadelphia: Elsevier; 2018: 1576.