In this interview, Doug discusses the skin findings that can point to COVID-19 infection and the cutaneous reactions clinicians may see following the vaccine.

In this video

Doug distinguishes the early, predromal skin signs of COVID from later findings. Early on, patients — especially children — may show oral presentations like glossitis, tongue changes, or aphthous lesions, along with a maculopapular or even urticarial eruption appearing at symptom onset or within 24 to 48 hours. The chilblains-like changes in the hands and feet, by contrast, are a late finding.

On "COVID toes," Doug notes that what started as a joke early in the pandemic turned out to be the most well-documented dermatologic finding. It's more common on the feet than the hands, appears 12 to 14 days after symptom onset, tends to occur in milder cases, and usually resolves within one to two weeks — often with skin shedding over the affected areas. Unlike true perniosis, it doesn't worsen with cold, is non-pruritic, and is more painful. He also covers vaccine reactions across all three vaccines, where fixed, localized reactions at the injection site — appearing six to eight days out — are by far the most common.

  • Early COVID skin signs include oral changes (glossitis, aphthous lesions), especially in kids, plus maculopapular or urticarial eruptions at or shortly after symptom onset; chilblains-like hand and foot changes are a late finding.
  • "COVID toes" is the most well-documented dermatologic finding — more common on the feet, appears 12–14 days after onset, is associated with milder disease, and typically resolves in one to two weeks with exfoliation.
  • COVID toes differs from perniosis: it doesn't worsen with cold, is non-pruritic, and is more painful.
  • The most common vaccine reaction across all three vaccines is a fixed, localized urticarial or plaque-like reaction near the injection site, typically 6–8 days after the shot; systemic reactions can also mimic morbilliform, urticarial, pityriasis rosea, or chilblains-like presentations.
  • A localized reaction to the first dose is not a reason to skip the second; treat with ice packs, H1 antihistamines, and topical steroids, and rule out COVID with more widespread presentations.