Doctors notice recent uptick in so-called COVID toes cases in children

Doctors notice recent uptick in so-called COVID toes cases in children

TORONTO — A Toronto doctor is suggesting that parents look at their children’s feet to see if there are unusual lesions around the toes that could be a sign of possible COVID-19 infection.

Dr. Elena Pope, the paediatric dermatology section head at the Hospital for Sick Children, said there has been an uptick in skin presentations of this nature — so-called COVID toes — in otherwise asymptomatic kids over the last few weeks in North America.

“The kids are not really bothered by those lesions and I think that’s why it took a while for this to come to the forefront,” she said. “If they were not bothered by it, they maybe didn’t actually report it to their parents … most of the lesions disappear on their own. They fade over time.”

Pope said there have been some cases where fingers are affected as well. The lesions have a red or purple colour and look similar to frostbite.

The Canadian Paediatric Surveillance Program (CPSP) issued a public health alert to clinicians this week, advising that these skin lesions should prompt COVID-19 testing. Pope and Dr. Irene Lara-Corrales, a paediatric dermatologist at Sick Kids, helped craft the alert.

“Overall I would emphasize that this seems to be an unusual manifestation in children who potentially have COVID infection and potentially are contagious at the time of the diagnosis, but they’re otherwise asymptomatic and that it seems to resolve spontaneously over several weeks,” Pope said.

Pope suggested that if lesions are discovered, virtual doctor care would be a good first step.

“From what we have gathered so far is the kids present with either itching or some mild pain in their toes associated with some swelling, and then they develop red or purple bumps that are persistent afterwards,” Pope said. “Very few of them may actually have skin breakdown.”

Definitive research in the area is still in the formative stages and specifics on case numbers have not been released. Registries have started around the world to track skin condition cases that may be connected to the novel coronavirus.

Pope said it was unusual to see such a significant uptick in similar skin presentations on a regular basis.

“I might see maybe less than five cases a year and nowadays we’re seeing many, many, many patients with this manifestation,” she said, speaking about the uptick here and in other countries.

They have decided that if the lesions are within the first two weeks of onset, it’s worth testing those patients for COVID-19.

“There have been case reports from other highly endemic areas of the skin manifestation in association with the positive swabs from COVID. And also, in some of the cases, there was evidence of antibodies. So in other words, there was evidence that the patients were exposed to COVID and had antibodies to the virus.

“So I think it’s fair enough to say that based on all those reasons, this is a true association with COVID. What is unusual about this presentation is that children are otherwise asymptomatic. So they don’t have the classic symptoms of COVID.”

Lesions may resemble chilblains or perniosis, a condition that doctors sometimes see in the spring when children are a little too eager to take off their boots and freeze their feet by wading in puddles of cold water, said Dr. Chantal Bolduc, a dermatologist at Universite de Montreal hospital centre.

“We are not sure it is a sign of COVID, but we think so because of the context,” Bolduc said. “We see a little more cases than usual, and cold temperatures aren’t a factor, and it’s happening at the same time as the pandemic.”

The majority of children showing the lesions don’t have a cough or a fever, she said.

“From what has been reported so far, this is something that seems quite benign. The children are not sick. It suddenly appears and it seems a little odd, the children are in good health, it goes away on its own in two to four weeks,” Bolduc said.

Symptoms may take up to 14 days to appear after exposure to COVID-19. They may also include cough, fever and shortness of breath.

“The good news for us is that the kids don’t seem to have any other major manifestations and they simply recover quite fast from this, so that’s reassuring,” Pope said. “But it would be important for us to understand more about the mechanism and why this is happening and why it’s happening primarily in children.”

—With files from Jean-Benoit Legault in Montreal

This report by The Canadian Press was first published May 1, 2020.

Follow @GregoryStrongCP on Twitter.

Gregory Strong, The Canadian Press

Coronavirus

Get local stories you won't find anywhere else right to your inbox.
Sign up here

Just Posted

school
Rimbey Christian School building projects nearing completion

New gym, soccer field and skating rink will be open to community use as well

SARS-CoV-2 virus particles, which causes COVID-19, emerge from the surface of cells isolated from a patient in the U.S. and cultured in a lab in a 2020 electron microscope image. THE CANADIAN PRESS/AP-HO, National Institute of Allergy and Infectious Diseases - Rocky Mountain Laboratories
Alberta now has 17,743 active cases of COVID-19

Province now has 17,743 active cases

Alberta’s chief medical officer of health, Dr. Deena Hinshaw, confirmed eight additional virus-deaths Monday afternoon including one in central zone. (Photo by Chris Schwarz/Government of Alberta)
Central zone up to 1,249 active COVID-19 cases

Red Deer sits at 257 active COVID-19 cases

Kelowna RCMP Stock Image.
Bentley post office damaged, armed robbery at Subway

Sylvan Lake RCMP respond to incidents in Bentley last month

Ten-month-old Aidan Deschamps poses for a photo with his parents Amanda Sully and Adam Deschamps in this undated handout photo. Ten-month-old Aidan Deschamps was the first baby in Canada to be diagnosed with spinal muscular atrophy through Ontario’s newborn screening program. The test was added to the program six days before he was born. THE CANADIAN PRESS/HO, Children’s Hospital Eastern Ontario *MANDATORY CREDIT*
First newborn tested for spinal muscular atrophy in Canada hits new milestones

‘If Aidan had been born any earlier or anywhere else our story would be quite different’

People line up at a COVID-19 assessment centre during the COVID-19 pandemic in Scarborough, Ont., on Wednesday, December 2, 2020. Toronto and Peel region continue to be in lockdown. THE CANADIAN PRESS/Nathan Denette
COVID-19 vaccine approval could be days away as pressures mount on health-care system

Many health officials in regions across the country have reported increasing pressures on hospitals

File Photo
Sylvan Lake Town Council squashes mask bylaw

The bylaw did not make it past first reading, after a 4-3 vote defeated the motion

A logo for Netflix on a remote control is seen in Portland, Ore.,Aug. 13, 2020. Experts in taxation and media say a plan announced Monday by the government will ultimately add to the cost of digital services and goods sold by foreign companies. THE CANADIAN PRESS/AP-Jenny Kane
‘Netflix tax’ for digital media likely to raise prices for consumers, experts say

The government says Canadian companies already collect those taxes when they make digital sales

Gaming content was big on YouTube in 2020. (Black Press Media files)
What did Canadians watch on Youtube during isolation? Workouts, bird feeders

Whether it was getting fit or ‘speaking moistly,’ Canadians had time to spare this year

A teacher places the finishing touches on the welcome sign at Hunter’s Glen Junior Public School which is part of the Toronto District School Board (TDSB) during the COVID-19 pandemic in Scarborough, Ont., on Sept. 14, 2020. THE CANADIAN PRESS/Nathan Denette
Hindsight 2020: How do you preserve a year many Canadians would rather forget?

Figuring out how to preserve the story of the pandemic poses a series of challenges

Team Manitoba celebrate after defeating Team Ontario to win the Scotties Tournament of Hearts in Moose Jaw, Sask., Sunday, Feb. 23, 2020. Curling Canada wants Calgary’s Canada Olympic Park to be a curling hub for the season’s top events. THE CANADIAN PRESS/Jonathan Hayward
Calgary facility set to become curling hub during pandemic

Curling Canada has provisional approval for Calgary’s hub-city concept from Alberta Health

Most Read