‘COVID toes’: Clue you could have virus
The known symptoms of the coronavirus are well established: a dry cough, muscle aches, fevers, chills, headaches and even losing your sense of taste and smell.
But there are emerging questions over whether strange chickenpox-style rashes, hives, broken blood vessels, and even what's being called "COVID toes" could provide a clue that some people are infected, particularly teenagers and children.
Doctors first started noticing rashes on COVID patients in Italy. Viral rashes can, of course, occur when anyone has a virus.
Some of these rashes, known as viral exanthema, are common and can often pop up when you're sick with a range of illnesses.
But when dermatologists in Lombardy, Italy investigated the rate of skin-related symptoms in COVID-19 patients, they discovered one in five coronavirus patients had developed a rash at the onset of the virus or after they were hospitalised.
The rashes included a red rash known as erythematous, hives, and a chickenpox-style rash.
COVID TOES! As more patients throughout the country are getting tested for COVID-19 and more research is being conducted, more symptoms are starting to emerge, including signs and skin changes to your feet...Sudden onset increase redness, pain, blistering, itchiness. #COVIDTOES pic.twitter.com/ldm7zA5BqQ— Jason Mendivil, DPM (@Dr_JMendivil) April 22, 2020
In Thailand, one patient developed a skin rash with what is known as petechiae or round purple, brown or red spots that were mistaken for a symptom of dengue fever.
Texan dermatologist Dr Sanober Amin sparked international interest when she suggesting that "some skin findings are more consistent with superficial clotting in blood vessels close to the skin".
"It looks like the blood vessels are getting clotted so patients are presenting with painful bumps on their toes. A lot of these patients are younger population and most of them didn't have any COVID symptoms or had mild symptoms to begin with," she said.
When Dr Amin recently posted images on social media about a range of skin rashes being reported among COVID patients, she got a huge response.
Her work has raised more questions over how COVID is more than a respiratory illness and is attacking the vascular system targeting the lining of blood vessels, which can lead to multiple organ failure in some cases.
In one case, a 67-year-old COVID-19 patient developed a rash on his inner thigh and began urinating blood.
Doctors believed the rash, called a transient livedo reticularis, was blocking the blood vessels in the patient's kidney, causing him to urinate blood.
For some scientists, it's more evidence that COVID is one of the "great imitators" because it can present with symptoms that can sound like gastro, a cold or the flu.
"There's clearly a respiratory syndrome, and that's why people end up in the hospital. Some people get a gastrointestinal illness with diarrhoea, maybe some abdominal pain, which may or may not be associated with a respiratory illness," Dr Joseph Vinetz, an infectious disease specialist at Yale School of Medicine said.
But Australian infectious diseases expert and ANU Professor Peter Collignon remains cautious.
"The one thing that you have to be a bit careful of is people with COVID can have other infections too,'' he said.
"And some of those pictures looked like foot and mouth disease, which is a virus children get. So, you've got to be careful that what's being attributed to COVID is not just another virus they have at the same time.
"You can't assume that just because someone has COVID that COVID is the cause of a rash."
The phenomena of COVID toes, which look like chilblains, has also been attracting worldwide attention.
"They're typically painful to touch and could have a hot burning sensation," the University of Pennsylvania's chief of infectious disease Dr Ebbing Lautenbach told USA Today.
"This is a manifestation that occurs early on in the disease, meaning you have this first, then you progress," Dr Lautenbach said. "Sometimes this might be your first clue that they have COVID when they don't have any other symptoms."
But the World Health Organisation does not yet recognise rashes and "COVID toes" as a symptom and more work needs to be done to investigate what's going on.
"The short answer is, nobody knows," Dr Lautenbach said.
Samantha Maiden is news.com.au's national political editor | @samanthamaiden
Originally published as 'COVID toes': Clue you could have virus