Experts now warn about ‘Covid toes’

A recent study published in the British Journal of Dermatology has raised concerns over Covid toes

It is now known that Covid-19 survivors have to go through short and long-term complications, both psychological and physical. A recent study published in the British Journal of Dermatology has raised concerns about a condition called ‘Covid toes' which causes inflammation in the toes and, if untreated, causes an autoimmune disorder.

Dr Wiqar Shaikh, professor of medicine, Grant Medical College and Sir JJ Group of Hospitals, says the Covid-19 virus is a peculiar one. It has led to some unusual symptoms and manifestations such as loss of taste and smell, myocarditis (swelling of the heart muscles), kidney failure, anxiety and depression, long Covid, in which symptoms could remain for up to six months after the infection, etc. "A a rather unusual presentation of Covid-19 is Covid toes which results in chilblain-like swellings and redness of the hands and toes. A chilblain is a condition which occurs in response to repeated exposure to cold and results in inflammation (swelling) of small blood vessels in the skin leading to skin sores or bumps on the fingers and toes."

Dr Shaikh said Covid toes have been reported from several countries in the world including Europe and North America. He quoted a study from Paris, published in the British Journal of Dermatology on October 4, in which 50 patients were studied. He said the study revealed high levels of what are called autoantibodies, antibodies produced by the body's defence or immune system which attack the body and destroy it. Dr Shaikh said the study revealed an increase in Type 1 interferon, a key protein in the anti-viral response of the human body, which in the case of Covid infection triggers a massive response of the immune system resulting in production of IgA type of antibodies. This was found in 73% of the patients studied. This results in production of ANCA (antinuclear cellular antibodies) which lead in turn to swelling of the blood vessels of the patient, a condition called vasculitis. The entire immunological procedure is what is called an autoimmune response, in which the immune system destroys one's body.

Dr Shaikh added that there are several autoimmune diseases known to mankind, including the dreaded Systemic Lupus Erythematosus (SLE). "We could be looking at the beginning of a wave of autoimmune diseases in patients who have had Covid-19. An ominous thought and possibility," he said. "The symptoms of chilblain-like inflammation and redness on the hands and feet, develops within 1-4 weeks of being infected and can result in swelling and hematomas on toes, and fingers also become swollen and red. Many people who have got Covid vaccines have also seen occurrence of similar conditions within 1-4 weeks of the vaccine shots, and this is attributed to autoimmune reactions caused by circulating viral antigens. This condition is self-resolving in most patients, although more widespread coagulation in vital organs will require urgent treatment with steroids", said Dr Subhash Hira, Professor of Global Health at University of Washington-Seattle.

"We have to study all post-Covid patients closely to rule out possibilities of other autoimmune diseases like SLE. Autoimmune diseases are chronic diseases and we need to educate all doctors to screen post-Covid patients for them. Also, when we see any new patient of autoimmune disease, we must ask about past history of Covid infection," said Dr Santosh Bansode, Head of the Department, Emergency Medicine, Wockhardt hospital. "We should educate people about these new findings so that they can take maximum precautions. Also, patients who already suffered from Covid should observe themselves for any abnormal symptoms and consult a doctor immediately," Dr Bansode concluded. "What causes this is unknown. There is no specific treatment besides topical steroid creams which itself is debatable. Therefore, it is advisable that if any such lesions develop immediate dermatologist or physician consultation is necessary," said Dr Ketan Vagholkar, professor of surgery at DY Patil Medical College.