Pediatric COVID toes and fingers

Abstract

\n The emergence of the COVID-19 world-wide pandemic has been associated with a new constellation of cutaneous features in children. Among the unusual dermatologic presentations are the so-called COVID toes, inflammatory nodules of the feet and toes, sometimes involving the hands and fingers. These lesions mimic acral pernio, the synonym being chilblains. Unlike adult patients with COVID toes, children are less likely to manifest symptomatic COVID-19. While a few studies have found some linkage to COVID-19 through serum IgA or IgG SARS- CoV-2 spike protein, other studies have no demonstrable linkage suggesting barefoot children in cold weather develop such lesions. It appears that the chilblains like lesions related to the time period of the COVID-19 pandemic may reflect a brisk immune response portending a good prognosis and perhaps some form of innate immunity. The possible need to screen for coagulopathy is unclear, but this has been suggested in one report. Until we fully understand the pattern of immune response to COVID-19, questions may persist as to how disease manifestations are linked to SARS-CoV-2 exposures.\n