Abstract
‘Covid toes’ are being seen with increasing frequency in children and young adults during the COVID‐19 pandemic. Patients present with reddish or purple lesions (affected skin patches) located on the hands and/or feet, particularly fingers and toes. Detailed descriptions of biopsies of Covid toes have not been reported, and the virus called coronavirus SARS‐CoV‐2, which causes the disease COVID‐19, has not been firmly established as the cause yet as most of the patients are negative for SARS‐CoV‐2 conventional tests (in which samples are taken from the nose and/or mouth). We examined skin biopsies from seven paediatric (child) patients presenting with Covid toes during the COVID‐19 pandemic in Madrid, Spain. The presence of coronavirus SARS‐CoV‐2 was investigated by electron microscopy and immunohistochemistry (staining that uses an antibody to recognise the virus). Our findings demonstrated the presence of vascular (blood vessel) damage and SARS‐CoV‐2 viral particles within the damaged endothelial cells (internal layer of blood vessels). Although the clinical features, meaning those seen outwardly, and histopathological features, meaning those seen in tissue samples, were similar to conventional chilblains, which are caused by cold temperatures, the presence of viral particles in the blood vessels and the evidence of vascular damage, support the idea that SARS‐CoV‐2 causes the lesions. Vascular damage caused by the virus could be a key mechanism to explain Covid toes and perhaps also other types of lesions seen in patients severely affected by COVID‐19. These findings can also help us to find a treatment focused on avoiding the vascular damage caused by the virus. Linked Article: Colmenero et al. Br J Dermatol 2020; 183:729–737.