COVID toes following vaccination.

Cutaneous manifestations of COVID-19 infections include "COVID toes." These are pernio-like, pale purple, painful, ill-defined cyanotic lesions that have inflammatory infiltrates on histologic studies. COVID toes can also develop following COVID vaccination. COVID toes was reported by 29 individuals to the Vaccine Adverse Event Reporting System maintained by the Centers for Disease Control and Prevention through May 25, 2021. The mean age of these individuals was 52 ± 18 years; 23 (79%) were women. They had received both mRNA vaccines and the adenovirus vector-based vaccine. This discoloration developed 4.5 ± 9.8 days following vaccination, usually after the first dose. Four individuals required hospitalization for systemic symptoms, and one died. This information indicates that some individuals develop important clinical syndromes following vaccination and suggests that some of the manifestations of COVID-19 infection represent immune responses and not necessarily active tissue infection.