Not COVID Toes: Pool Palms and Feet in Pediatric Patients
So-called COVID toes is probably the most publicized cutaneous manifestation of COVID-19. The parents of 4 patients pursued dermatology evaluation with concerns about COVID-19 infection in their children who presented with symmetric, focal, erythematous lesions of the hands or feet, or both. We elicited a history of extended time in swimming pools for the 4 patients that was associated with COVID-19 restrictions during summer months of the pandemic and recognized findings of frictional and pressure-induced erythema and scaling, leading to a diagnosis of pool palms and feet—an extension of pool palms. It is important to recognize this diagnosis and provide reassurance to the patients and caregivers because the condition warrants no notable workup or therapeutic intervention.
Pool palms and feet is benign. Only supportive care, with cessation of swimming and application of emollients, is necessary.
Apart from COVID-19, other conditions to consider in a patient with erythematous lesions of the palms and soles include eczematous dermatitis; neutrophilic eccrine hidradenitis; and, if lesions are vesicular, hand-foot-and-mouth disease. Juvenile plantar dermatosis, which is thought to be due to moisture with occlusion in shoes, also might be considered but is distinguished by more scales and fissures that can be painful.
Location of the lesions is a critical variable. The patients we evaluated had lesions primarily on palmar and plantar surfaces where contact with pool surfaces was greatest, such as at bony prominences, which supported a diagnosis of frictional dermatitis, such as pool palms and feet. A thorough history and physical examination are helpful in determining the diagnosis.
Practical Implications
It is important to consider and recognize this localized pressure phenomenon of pool palms and feet, thus obviating an unnecessary workup or therapeutic interventions. Specifically, a finding of erythematous asymptomatic macules, with or without scaling, on bony prominences of the palms and soles is more consistent with pool palms and feet.
Pernio and COVID toes both present as erythematous to violaceous papules and macules, with edema, vesiculation, and ulceration in severe cases, often on the dorsum and sides of fingers and toes; typically the conditions are pruritic and painful at times.
Explaining the diagnosis of pool palms and feet and sharing one’s experience with similar cases might help alleviate parental fear and anxiety during the COVID-19 pandemic.
