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Published on: May 22, 2020
1 minute read
By: Dr Rajan Choudhary

Corona Virus In Young Patients And Kids

Kids seem to be relatively unaffected by COVID, but this does not mean they are invulnerable. As with adults, some children have pre-existing cardiac, respiratory, or metabolic conditions, and are therefore more vulnerable to the effects of COVID. Interestingly, children appear to have one more symptom when infected with coronavirus – COVID Toes.

I personally came across this phenomenon recently, with a young patient asymptomatic for COVID who presented with unusual symptoms of dark bruises on his toes. This had been present for just a few days. He did not have any pain, itching, swelling, no recent trauma, or injury to the feet. Circulation to his feet was normal, with no other rashes or skin changes, no other abnormal features in the history to note. It was certainly an odd presentation and certainly could have been an example of COVID toes.

This new phenomenon was noticed in April and has not gained as much notoriety because it is fairly rare compared to the major COVID symptoms, such as fever, cough, and lethargy. Doctors have described lesions on the feet of young people, usually purple-colored, around the tips of the toes. They have been compared to chilblains, painful swellings on feet, and toes that appear in the cold. Similarly to chilblains they do not cause any permanent damage and usually regress in days to weeks.

It's not clear why they occur or the mechanism behind the discoloration, because the presentation is rare and in healthy patients. We know COVID can cause systemic inflammation and can increase the risk of clot formation. It may be that localized inflammation is occurring in the toes, causing the vessels to clamp down and reduce blood flow to the area. This is similar to the mechanism for chilblains forming in the foot. Micro-clotting could also be partially responsible for this phenomenon.

COVID Toes is not the only skin symptoms related to COVID. In a paper published in the British Journal of Dermatology, researchers described five common skin presentations in 375 COVID patients. These were:

Asymmetrical chilblain like lesions in the hands and feet, found in younger patients lasting up to 2 weeks.
Small itchy blisters in the trunk and limbs, found in middle-aged patients before they present with symptoms, lasting about 10 days
Pink or white areas of raised skin, itchy, usually on the body
Raised bumps called macropapules, lasting about a week, seen in more severe infections.
Mottled, blotchy red-blue skin (known as livedo) seen in patients with severe illness.

So if you are currently suffering from COVID or have recently recovered from an infection, and suddenly notice odd colored toes, you too may have a case of COVID toes.

Dr Rajan Choudhary, UK, Chief Product Officer, Second Medic Inc

www.secondmedic.com

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Yellow Eyes and Skin Symptoms: Causes, Warning Signs and When to Seek Care

Yellowing of the eyes and skin is one of the most noticeable physical changes a person can experience. Often referred to as jaundice, this symptom is not a disease by itself but a sign of underlying health conditions. Understanding yellow eyes and skin symptoms is essential because they frequently indicate problems involving the liver, blood or bile ducts and may require urgent medical attention.

In India, jaundice is a common presentation across age groups due to infections, liver disease and metabolic disorders.

What Does Yellowing of Eyes and Skin Mean?

The yellow colour appears due to excess bilirubin in the blood.

Bilirubin is:

a yellow pigment
produced from the breakdown of red blood cells
processed and removed by the liver

When bilirubin builds up, it deposits in tissues, causing yellow discoloration.

Why the Eyes Turn Yellow First

The sclera, or white part of the eyes, contains elastic tissue that binds bilirubin easily.

This makes yellowing:

more visible in eyes
detectable before skin changes

Yellow eyes are often the earliest sign of jaundice.

Common Causes of Yellow Eyes and Skin

Liver-Related Causes

The liver plays a central role in bilirubin metabolism.

Common liver causes include:

viral hepatitis (A, B, C, E)
fatty liver disease
alcoholic liver disease
liver cirrhosis
drug-induced liver injury

ICMR reports viral hepatitis as a major cause of jaundice in India.

Bile Duct Obstruction

Blocked bile flow prevents bilirubin excretion.

Causes include:

gallstones
bile duct strictures
pancreatic or bile duct tumours

This type of jaundice is often associated with itching and pale stools.

Blood Disorders

Excess breakdown of red blood cells increases bilirubin production.

Conditions include:

hemolytic anemia
malaria
inherited blood disorders

The liver may be overwhelmed despite being healthy.

Infections

Certain infections directly affect liver function.

Examples include:

hepatitis viruses
leptospirosis
severe sepsis

WHO data highlights hepatitis as a leading infectious cause of jaundice globally.

Newborn and Pregnancy-Related Causes

While common in newborns, jaundice in adults always needs evaluation.

Pregnancy-related liver disorders can also cause yellowing.

Associated Symptoms That Provide Clues

Yellow eyes and skin are often accompanied by:

dark yellow or tea-coloured urine
pale or clay-coloured stools
itching
fatigue
abdominal pain
loss of appetite

These symptoms help identify the underlying cause.

When Yellowing Becomes Dangerous

Seek urgent medical care if yellowing is accompanied by:

high fever
severe abdominal pain
confusion or drowsiness
vomiting
rapid worsening of colour

These signs suggest severe liver or systemic disease.

Jaundice and Liver Function

The liver normally:

conjugates bilirubin
excretes it into bile

When liver cells are damaged, bilirubin accumulates.

Lancet studies confirm jaundice as a key marker of liver dysfunction.

Diagnostic Evaluation

Doctors evaluate jaundice using:

blood tests for bilirubin levels
liver function tests
viral markers
ultrasound or CT scans
additional tests based on findings

Early testing identifies reversible causes.

Impact on Daily Life

Persistent jaundice can affect:

energy levels
digestion
mental clarity
work performance

Untreated liver disease can progress silently.

Treatment Depends on the Cause

There is no single treatment for jaundice.

Management focuses on:

treating infection
relieving bile obstruction
stopping harmful medications
managing chronic liver disease

Self-medication can worsen liver injury.

Role of Preventive Healthcare

Preventive measures include:

hepatitis vaccination
safe drinking water
limiting alcohol intake
regular health checkups

NITI Aayog emphasises liver health in preventive care strategies.

Lifestyle Factors That Affect Liver Health

Risk factors include:

excessive alcohol
obesity
high-fat diets
unsafe injections

Addressing these reduces jaundice risk.

Importance of Early Detection

Early diagnosis:

prevents complications
improves recovery
reduces hospitalisation

Delays increase the risk of liver failure.

Jaundice Is a Symptom, Not a Diagnosis

Understanding this distinction is crucial.

Treating the symptom alone:

does not resolve the disease
may mask serious conditions

Medical evaluation is essential.

Conclusion

Yellow eyes and skin symptoms are visible warning signs that should never be ignored. Most often linked to jaundice, they reflect underlying problems involving the liver, bile ducts or blood. Early medical evaluation, accurate diagnosis and timely treatment are critical to prevent serious complications. Recognising these symptoms and seeking care promptly can protect liver health and save lives.

References

Indian Council of Medical Research (ICMR) – Hepatitis and Liver Disease Reports
World Health Organization (WHO) – Jaundice and Hepatitis Guidelines
National Family Health Survey (NFHS-5) – Liver and Metabolic Health Indicators
Lancet – Liver Function and Bilirubin Research
NITI Aayog – Non-Communicable Diseases and Liver Health
Statista – Liver Disease and Hepatitis Trends

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