Special to the Lake Okeechobee News/Dr. Amy Paller Northwestern University
A patient’s toes show the onset of the condition dubbed COVID-19 toes.

OKEECHOBEE — Dr. Ted Schiff, of Water’s Edge Dermatology, has a message for parents: Check your children’s fingers and toes.

Painful, purple spots on toes and fingers may be an early indicator of the COVID-19 virus, he said.

“It is not an uncommon finding in coronavirus,” Dr. Schiff explained. People who develop other COVID-19 symptoms may develop these skin findings.

With children and young adults, the spots may be the only sign of COVID-19 infection. Pediatric dermatologists have found children who appear healthy will test positive for COVID-19.

“This is the only clue they may have,” he said.

It is not uncommon for viruses to cause “skin findings,” the doctor continued. Measles and chickenpox cause spots on the skin.

The spots may be caused by the constriction or occlusion of a blood vessel. He said the blood vessels can open and close based on impulses from the nervous system and the virus can affect the nervous system. “The reason it is occurring has not been worked out,” he added.

Dr. Schiff said he has not seen any patients with the spots in Okeechobee, but his colleagues have seen them on young patients in coastal counties.

For adults, the spots may be just one more symptom of COVID-19 for someone who already has a fever, difficulty breathing and other symptoms. Children may feel fine and appear healthy but carry the virus. On a child, the spots or a rash may be the only sign something is wrong.

What should parents do?

“If I were a parent and I saw this, I would protect others from this child,” he continued. This is a sign the child might have COVID-19 and a good reason the child should be tested, he explained.

The spots are just an indicator, he advised. It does not mean the child has coronavirus. “There are other reasons for children to develop this type of spot.

“View them as infected and infectious and protect other family members from exposure to this child, especially grandparents and others with conditions that make them more at risk, such as hypertension and diabetes.”

Dr. Schiff said while Okeechobee County appears to have only a few confirmed cases of COVID-19, most people assume there are more infected people who have not been tested. If one parent in Okeechobee finds the spots and prevents the virus from being spread to others, “it could save a life.”

While some children have died from COVID-19 complications, it is rare, he added. Most children who are infected show no signs or only mild symptoms. The greater danger is that the infected child may expose others who are more at risk to the virus.

These purple or reddish spots on the toes sometimes encompass the entire tip of the toe, occasionally scab and can be painful. The medical term for these spots is chilblains (also known as pernio). If a child has these spots, parents are advised to consult a dermatologist, primary care physician or pediatrician.