Trending Clinical Topic: COVID Toes

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MAY 08, 2020 -- New reports of unusual symptoms associated with COVID-19 resulted in this week's top trending clinical topic. The American Academy of Dermatology is one of many societies that have launched registries to share information about COVID-19 cases. "COVID toes" are among the more commonly reported dermatologic manifestations. Lesions that appear on the feet of patients with COVID-19 have been described as resembling those seen in individuals exposed to cold temperatures. Many of the reported cases involve children. Dermatologists note that confirming which skin conditions are directly related to COVID-19 is challenging because many of those without "typical" symptoms are not being tested for coronavirus infection.

Although COVID toes may be reported more commonly among younger individuals, atypical symptoms have also been reported among older adults with COVID-19. The characteristic symptoms of fever, cough, and shortness of breath may be absent in the elderly, who instead may seem simply "off" soon after becoming infected with the coronavirus, sleeping more often than usual, acting apathetic or confused, and being disoriented to place. Neurologic symptoms have also been described in other populations, with encephalopathy, ataxia, and even strokes reportedly associated with COVID-19. In New York City, one neurosurgery department reported five cases of large vessel stroke over a 2-week period among patients with COVID-19 who were younger than 50 years. That is a sevenfold increase over what normally is seen.

Some symptoms have become more widely accepted as being attributable to COVID-19. The Centers for Disease Control and Prevention added six new symptoms to its list for COVID-19: chills, muscle pain, headache, sore throat, repeated shaking with chills, and a loss of taste or smell. Some experts argue that a new loss of smell and/or taste should be part of COVID-19 screening. Those symptoms reportedly occur early in the disease course, and screening for them does not require any procedure. Results of a study published in the International Forum of Allergy & Rhinology showed that 68% of patients with COVID-19 had olfactory impairment and 71% had taste impairment, whereas only 16% and 17% in the control group experienced loss of smell or taste, respectively.

COVID toes may have captured the most attention this week, but a wide variety of symptoms that may be associated with coronavirus infection have come under clinicians' scrutiny. As further research and investigation provide a more definitive link for some, more symptoms are likely to become trending clinical topics.

COVID toes infographic

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