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

Alberta chief medical officer of health Dr. Deena Hinshaw said the province still hopes to bring the hospitalization number down before relaxing restrictions. (photography by Chris Schwarz/Government of Alberta)
14 new deaths, 366 new COVID-19 cases in Alberta

Province nearing 100K COVID-19 vaccine doses administered

The first pages of the book, by Kristy Walker.
Sylvan Lake author pens first children’s book about COVID-19

“The Coronavirus Isn’t Scary” by Kristy Walker teaches children to take care of themselves

Minister of Agriculture and Forestry, MLA Innisfail-Sylvan Lake, Devin Dreeshen. (Photo Submitted)
Ag Minister announces 20% off crop insurance for Alberta farmers

Dreeshen says this will support job creators and boosting rural economy during a difficult time

An x-ray tech demonstrates the new equipment in use. (Photo Submitted)
New diagnostic equipment now operational at Sylvan Lake AACS

In August it was announced that Stephen and Jacqueline Wuori donated $850,000 to AACS

Terrance Josephson of the Princeton Posse, at left, and Tyson Conroy of the Summerland Steam clash during a Junior B hockey game at the Summerland Arena in the early spring of 2020. (John Arendt - Summerland Review)
QUIZ: How much do you know about hockey?

Test your knowledge of Canada’s national winter sport

(Photo submitted)
Central Alberta researchers recognized for studies in agricultural sciences

Jessica Sperber of Ponoka and David MacTaggart of Lacombe awarded prestigious scholarship

FILE – Canadian Prime Minister Justin Trudeau delivers his opening remarks at a news conference outside Rideau cottage in Ottawa, Tuesday, January 19, 2021. THE CANADIAN PRESS/Adrian Wyld
Vaccine CEO ‘very, very clear’ that Canada’s contracts will be honoured: Trudeau

Trudeau says he spoke to Moderna CEO on the morning of Jan. 26

A ground worker wearing a face mask to curb the spread of COVID-19 unloads lobsters from a WestJet Airlines flight at Vancouver International Airport, in Richmond, B.C., on Thursday, January 21, 2021. THE CANADIAN PRESS/Darryl Dyck
Trudeau teases stricter travel measures; Canadians flying to U.S. now need COVID test

Prime minister says measures need to not hurt imports and essential trade

(Photo submitted)
Ponoka RCMP receives new police puppy trainee

Detachment says goodbye to ‘Maja’ and welcomes ‘Neutron’

Art Kempf, originally from the Stettler area but now living in Lacombe, is pictured here with his late wife Lillian. Art’s 100th birthday is coming up on Feb. 22nd.
photo submitted
Former Stettler area resident Art Kempf will be celebrating a very special day next month

Kempf, now a Lacombe resident, marks his 100th birthday on Feb. 22nd

Whistle Stop Cafe owner Christopher Scott and his sister Melodie are serving sit-down customers in their Mirror diner to protest health restrictions that they say are unfair to restaurants and other small businesses. (Photo by Paul Cowley/Advocate staff)
Central Alberta restaurant owner defies health restrictions by serving diners

Whistle Stop Cafe owner says pandemic restrictions unfair to restaurants and small businesses

The Northwest Territories flag flies on a flagpole in Ottawa on July 6, 2020. THE CANADIAN PRESS/Adrian Wyld
Alberta man charged with threatening Northwest Territories public health officer

Police did reveal the nature of the threats, but said it was concerning

A healthy volunteer receives an injection in this undated handout image provided by Providence Therapeutics. Human clinical trials have begun in Toronto for a proposed COVID-19 vaccine by a Canadian company. Providence Therapeutics of Calgary says 60 subjects will be monitored for 13 months, with the first results expected next month. THE CANADIAN PRESS/HO-Providence Therapeutics
*MANDATORY CREDIT*
Calgary company begins human clinical trials for its COVID-19 vaccine candidate

If successful, the vaccine could be released by the end of the year

Most Read