Boston University Physician Uses VisualDx in Telemedicine Clinic

Hannah K., a physician at Boston University, describes how she used VisualDx in a telemedicine visit to diagnose COVID toes:

Young female in mid 20’s presented to telemedicine clinic and stated she developed painful red blisters and that pain persisted for a few weeks.

• She admits to pain, pruritis, sensitive feet/toes, and a tingling sensation
• Reports severe discomfort with ambulation so tried to walk with her toes lifted off the ground by heel walking
• She had developed red-purple circular lesions which eventually started to fade into a pink color
• Denies fever, chills cough, SOB, N/V/D
• She never had this problem before. She denies any history of joint pain, skin rash, CTD such as lupus or R arthritis.
• No history of Raynaud.
• Lesions eventually resolved on their own.

I used VisualDx to help in the diagnosis of this patient, which was “COVID toes,” also known as chilblains due to the coronavirus. VisualDx helped me reach this diagnosis with their photos and synopsis and what to look for.

Thank you Visual Dx. You are my go-to with my patient encounters!

What are COVID toes?

COVID toes are one of the main mucocutaneous manifestations of COVID-19 infection:

• Pernio-like lesions on the acral surfaces (also known as “COVID toes,” pseudo-chilblains, and acute acro-ischemia), including erythema, edema, vesiculation, and purpura of the toes, fingers, feet, and hands.
• Lesions may be painful, itchy, or asymptomatic.
• Feet have been noted to be affected more frequently than hands. These manifestations occurred in younger individuals late in disease course and usually followed a milder illness.

What should we be aware of when making a diagnosis?

Erythema is more readily appreciated in lighter skin colors. In darker skin colors, a deep red, maroon, or violaceous hue may be seen. In lighter skin colors, purpura may appear bright red, deep red, maroon, or violaceous. Purpura in darker skin colors will appear deep red, maroon, violaceous, or deep brown.

How can we treat this?

Management of COVID-19 depends on the severity of illness.

“COVID toes” typically self-resolve without treatment, but topical steroids may be used for symptomatic or persistent cases.