Have you got rashes on your feet and hands? The least known symptom of the coronavirus

A few days ago, Alejandro Díez, 24, from Madrid, got up with discomfort in his feet. I thought they were scratches or blisters after exercising in the patio of his house with some old slippers, but the thing was going to more. "The itch at night was quite insufferable", declares Teknautas. The strange injuries began to turn purple and his next theory was that it could be fungus, so he decided to go to the pharmacy. "They told me they had never seen him before, that he should go to the emergency department," he says.

From there, he began to worry and the surprise was complete at the health center: "They told me they were symptoms of coronavirus, they had already seen another couple of cases, and I was stumped, I thought it was a joke. "In an instant he was surrounded by several health professionals who were watching him and taking pictures of his foot.

Despite the initial diagnosis, he was sent home without treatment and his evolution worsened, with the appearance of thrombi in the affected area, so tests were eventually carried out in the hospital. Fortunately, he had no pneumonia and blood tests were normal, but his clinical diagnosis was Covid-19, although they did not perform the PCR. Other than foot injuries, he has only had headaches, dizziness, and some fever.

On the other hand, María Paz González, a pharmacist from Madrid, has been able to confirm her diagnosis with a positive PCR test. "I thought it was an allergy, I had a lot of snot and I lost my sense of smell, but four days later I went to get tested and when I walked I noticed pain in my toe," he says. "When I got home I had like a little bruise, which the next day was bigger and darker. My podiatrist told me he would have hit me without realizing it, but I knew he hadn't ", Add.

In general, his coronavirus symptoms have been very mild and even the pain in his foot went away quickly, but 15 days later he still has a small mark, "an insignificant little dot " which still reminds you that you have had Covid-19. Since dermatological conditions are not among the most talked about of this disease, his case and Alejandro's may seem atypical, but in reality they are being quite common.

"It has been an avalanche", says from his Vigo consultation Juan García Gavín, one of the dermatologists who from hospitals and private practices are providing data for an investigation into the skin manifestations of Covid-19. "At the beginning of the epidemic in Spain, dermatologists began to see skin lesions associated with the disease. Some patients began to consult us about hand and foot problems, but there are also many specialists who, due to healthcare needs, went from dermatology services to see coronavirus patients and realized that there were some characteristic injuries, "he explains.

Photo: Cedida

The truth is that "it is not uncommon for viral infections to appear skin lesions," he says. Therefore, through the Spanish Academy of Dermatology and Venereology, a the Covid-Piel scientific study with the intention of analyzing all the data that could be collected. Looking at hospitalized cases and consultations, dozens of experts across the country try to characterize the lesions to see if they can be valid as a criterion for diagnosing Covid-19 and if different types of skin manifestations can be associated with better or worse prognoses.

The first approaches to this problem, such as an article published in late March in the 'Journal of The European Academy of Dermatology and Venereology', suggested that 20% of patients could develop some type of skin lesion. It was a small study carried out with just over a hundred Italian patients and therefore this number could vary, but at the moment it coincides with the observations of Spanish dermatologists. "We are not talking about a small percentage and, furthermore, can occur during or after the typical symptoms of the disease ", comments the specialist in reference to cough, fever, dyspnea and the rest of the usual manifestations of Covid-19.

Different types of injury

Broadly speaking, the researchers are distinguishing between injuries presented by hospitalized patients with a severe infection and those of those who come to the clinic for the skin problem, with few or no other symptoms. The former have rashes, generalized skin rashes throughout the body, which occurs with some frequency in viral infections. Instead, specialists are more interested in injuries to the hands and feet of young people due to its rarity.

Due to their appearance, these manifestations could be classified as chilblains, stings, chafing and trauma. Technically, these are acroischemic lesions and "there is always a link with Covid-19, some cases confirmed by positive PCR, others that have had compatible symptoms and others that have simply lived with people who passed the disease ", says García Gavín. In this sense, since there are many asymptomatic patients, "a possible interpretation would be that they have passed the disease and then develop this type of injury, but it cannot be said 100%, they are working hypotheses." In any case, the mechanism by which it can happen is unknown, whether it is a direct action of the virus or not. "It could be possible that it was due to another causative agent and that the coronavirus is simply facilitating the occurrence of these injuries, so we will have to investigate," says the dermatologist.

The mechanism by which it can happen is unknown, whether it is the direct action of the virus or if it facilitates the appearance of lesions for other reasons.

The experts are very cautious while waiting for the study to provide clear conclusions since, in such an exceptional situation as the one we are experiencing, "there are many confounding factors, We have a pandemic and these cases appear, so we are forced to think that they are relatedBut there is also a confinement and the situation of the microbial environment will surely have changed. Hence the importance of the study to ensure that the injuries are caused by the virus and not for other related reasons. "

The study is led by Cristina Galván Casas (University Hospital of Móstoles, in Madrid) Alba Català Gonzalo (Hospital Plató de Barcelona) and Gregorio Carretero (Hospital Universitario Gran Canaria Doctor Negrín de Las Palmas de Gran Canaria) and the intention is to provide a final classification with different lesions related to SARS-CoV-2.

Although there are other investigations underway in other European countries, Spanish dermatologists believe that they are more advanced and that the results of his work will see the light in just two weeks. "We are going to be pioneers because having the misfortune of being one of the most affected countries we see many cases, but also because we have organized ourselves very quickly and we are going to have a great statistical analysis, it is going to be a milestone," he assures.

Importance to the forecast

After analyzing images of hundreds of cases and making their morphological description, this work can serve to have an added diagnostic criterion to the best known so far. In other words, it could be assessed whether any type of injury is so specific as to detect a patient with coronavirus due to the presence of these injuries, even if they do not suffer other symptoms.

Furthermore, an even more valuable utility can be derived from the Covid-Piel study: determine what will be the prognosis of the disease. "We could see if there is a relationship between certain types of injuries and severity. We would be facing very valuable clinical information, because if a patient comes to me with a type of injury that is worse in evolution, I can take measures sooner," says the expert.

Skin lesions, in themselves, have a slight character (Except in specific cases in which it has been proven that the interaction with drugs is causing more serious damages), so in general its treatment is current, with the exception of certain hospitalized patients. However, "some seem extraordinarily persistent, there are discharged patients who continue with them."