A case of cold, purple toes

Abstract

A 13-year-old girl presented to the Dermatology Clinic for evaluation of recurrently swollen, red and purple toes. She first noted the problem a year earlier, while gardening barefoot outside in the late fall. Although the lesions were not pruritic, she said they throbbed and were tender for a few weeks before they resolved spontaneously. Cold temperatures seemed to exacerbate the condition. She did not take any medications and denied any recent illnesses (including COVID-19 infection).What’s your diagnosis?