'COVID toes' may persist for months in long-haulers, study finds

A new study suggests that some COVID long-haulers may experience skin reactions for months after getting the virus. (Photo: Getty Images)
A new study suggests that some COVID long-haulers may experience skin reactions for months after getting the virus. (Photo: Getty Images)

A new large-scale analysis from the International League of Dermatological Societies and the American Academy of Dermatology suggests that some survivors of COVID-19 experience skin reactions long after contracting the virus — one of many side effects that the group, known as “long-haulers,” may endure.

The results, shared at the European Academy of Dermatology and Venereology Congress in Vienna, utilized an international registry of skin reactions to COVID-19 created by a global team of dermatologists. They found that while on average individuals experienced skin symptoms for 12 days, a subset of patients experienced them for 60 days or more.

Nearly 1,000 cases from 39 countries revealed what the authors called a “broad spectrum of dermatologic manifestations.” One of the most common was an inflammation of the blood vessels in the feet, nicknamed “COVID toes,” which in some lasted for as long as 150 days. Other common skin reactions included hives, a purple-like rash and reddened scaly changes in the skin.

Related: What are 'COVID toes'?

Leslie Richard, a COVID long-hauler from Louisiana — and member of the grassroots organization called Survivor Corps — says she developed “odd mysterious bumps” in the first week after getting diagnosed with COVID-19 in mid-March. “It felt like bugs were crawling all over my skin and stinging me regularly,” she tells Yahoo Life.

Two months ago she began experiencing a rash on her face, neck, shoulders, back and groin. “These rashes looked like a mix between bug bites, acne, hives and shingles,” says Richard. “I call them ‘shives’ since no doctor knows what it is. Eventually, they cluster and the skin becomes thick, hard and irritated. It is itchy, burns and stings.” Richard says she has tried many treatments but has yet to find anything that works.

Dr. Julia S. Lehman, an associate professor in the Division of Dermatopathology and Cutaneous Immunopathology at the Mayo Clinic, finds the rashes to be somewhat surprising. “While it is relatively common for patients to develop nonspecific exanthema (red, blotchy rash on chest, abdomen, and back) in response to viral infections, some of the skin changes that are being observed in patients affected by COVID-19 are unusual,” Lehman tells Yahoo Life. “For example, the retiform purpura (or jagged purple marks) in some very ill patients with COVID-19 appear to be due to the effect of this novel coronavirus on the blood clotting system, something which is not seen with most viral infections.”

She says that dermatologists are still working to figure out why COVID-19 patients develop COVID toes — and why, for some, they stick around. “The phenomenon of COVID toes seems to closely resemble changes that can be seen in perniosis, a condition known to cause violaceous to blue discoloration of the toes, fingers or tips of the ears,” Lehman says. “In perniosis, it is usually exposure to cool, damp conditions that causes inflammation to surround blood vessels. With perniosis, it is thought that the ears, toes and fingers seem to be preferentially affected, because they are cooler and, by virtue of being peripheral, have some of the smallest caliber blood vessels in the body.”

COVID toes aren’t the only symptoms plaguing long-haulers. A Survivor Corps member from Ohio, Lexi Riley-Dipaolo, says she’s been fighting a severe rash on her hands and wrists since getting diagnosed with COVID-19 this summer. The rash began as “small pustular vesicles” that eventually blistered and popped, leaving her hands raw and peeling. “At this point, they felt like they were on fire and were burning constantly,” she tells Yahoo Life. Although the blisters eventually healed, she says, new ones soon formed in their place, and the “whole cycle [began] again.”

Doctors have “bounced around many different diagnoses,” Riley-Dipaolo says, including psoriasis, eczema and celiac disease. But more than three months later, she still has yet to find a solution. “This has been going on since July, when I tested positive, with no relief,” she says. “No medications or creams have helped.”

In a statement on Eureka Alert, the study’s lead investigator, Dr. Esther Freeman, director of Global Health Dermatology at Massachusetts General Hospital, said the study provides further clues about the virus. “This data adds to our knowledge about how COVID-19 can affect multiple different organ systems, even after patients have recovered from their acute infection,” Freeman said. “The skin can provide a visual window into inflammation that may be going on elsewhere in the body."

Still, Lehman says that for long-haulers, there may be reason to hope. “When skin symptoms persist, it does not necessarily mean that the body is still infected,” says Lehman. “But rather, it probably means that the immune system is still recovering from the effects of their prior viral infection.”

For the latest coronavirus news and updates, follow along at According to experts, people over 60 and those who are immunocompromised continue to be the most at risk. If you have questions, please reference the CDC’s and WHO’s resource guides.

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