Researchers are debating whether ‘COVID toes’ are caused by an infection with SARS-CoV-2.
In March 2020, just as COVID-19 cases began to surge in Boston, Massachusetts, Esther Freeman noticed something peculiar—a deluge of people with discoloured toes requesting appointments. Freeman, director of global health dermatology at Massachusetts General Hospital, had seen these kinds of toes before. The itchy red and purple patches are a classic sign of chilblains, a skin condition that typically appears in cold weather. But usually, she would see one or two cases each winter.
Still, the results raise “some very interesting questions that deserve further study”, says Freeman, who was not involved in the research. For instance, the study doesn’t exclude the possibility that people exposed to the virus could have fought it off using an innate immune response—a first-line defence that would not prompt the body to produce detectable antibodies and T-cells against SARS-CoV-2. So for now, she adds, the mystery remains.
The researchers used a variety of methods to look for antibodies and T-cells specific to the coronavirus—signs of the body having what’s called an adaptive immune response to a pathogen. These people were months past the onset of their chilblains, so their immune systems would have had plenty of time to respond to SARS-CoV-2 if they had been infected. But the team picked up signs of a past infection only in two people, one of whom had initially tested positive.
Unsolved mystery Previous studies have examined whether people with chilblains had been infected with SARS-CoV-2 by taking tissue biopsies and staining the samples with a dye that identifies parts of the virus. Gehlhausen and colleagues tried the stain and found that it stuck to some of their tissue samples. But they also tested the stain on random tissue samples collected before the pandemic, when the virus was not in circulation, and found that it also marked some of those.
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