Background The role of SARS‐CoV‐2 as the cause of chilblains in children remains a matter of debate but it is important to elucidate it for patient isolation and contact tracing. We sought to define the etiology, clinical presentation, time course, and outcomes of children presenting to the emergency department (ED) with cutaneous manifestations shortly after the first pandemic peak of COVID‐19 in Spain. Methods A prospective, observational study in children <15 years of age evaluated for skin lesions in the EDs of three pediatric hospitals. Children underwent a comprehensive work‐up including tests for SARS‐CoV‐2 antibodies and polymerase chain reaction (PCR), and serology and PCR tests for other viruses and bacteria. A 1 month follow‐up visit was conducted. Results From April 14 through May 8, 2020, we enrolled 62 children. Of those, 34 had acro‐ischemic skin lesions and 28 had a variety of skin rashes. Overall, 40% of children had mild systemic symptoms. Children with chilblains were older, had pain more frequently and a more prolonged duration of skin lesions, while those with non‐specific rashes had fever more frequently. Lesions were resolved in 75% of children at follow up. Five patients demonstrated SARS‐CoV‐2 antibodies, and none tested positive with PCR. Three additional patients tested positive with PCR for rhinovirus, Mycoplasma pneumoniae and Chlamydia pneumoniae. Conclusions The number of ED visits for chilblains, which are rare in pediatrics, was high soon after the first peak of COVID‐19 in Spain. The disease course was self‐limited, outcomes were favorable, and the possibility of viral transmission was negligible as all patients tested negative for SARS‐CoV‐2 by PCR.

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Background25hydroxy-vitamin D not only plays a key role in calcium homeostasis, but also has antiinflammatory and immunomodulatory properties. Hypovitaminosis D prevalence in children suffering from Juvenile Idiopathic Arthritis (JIA) ranges from 6% to 30% according to different publications.ObjectivesEvaluate hypovitaminosis D prevalence in JIA pediatric patients in Spain and assess involved factors.MethodsObservational cross-sectional study in JIA Spanish patients from 4 to 15 years, monitored by a Pediatric Rheumatology Unit. Monoarticular forms and patients with other chronic diseases or receiving different treatments from those indicated for JIA were excluded.Anthropometric, clinical and treatment data were recorded. Bone metabolism parameters and validated diet (KIDMED) and exercise (PAQ-C/PAQ-A) questionnaires were obtained.Hypovitaminosis D was defined as 25hydroxy-vitamin D plasma levels lower than 30 ng/mlResults76 children participated. Their characteristics are included in table 1.The population's prevalence estimation of hypovytaminosis D in children with JIA was 16 - 35% (CI 95%).We found no relationship between 25 hydroxy-vitamin D levels and sex, JIA subtype neither duration or dose of systemic glucocorticoids.In bivariate analysis we found direct association between hypovitaminosis D and Body Mass Index percentile (BMIp) (p=0,05), received dose of prednisone (p=0,03) and clinical activity duration (p=0,04); and an inverse relationship with physical activity level (p=0,04).In multivariate analysis, relationship between hypovitaminosis D and BMIp (B 0,024; p 0,016) and with disease activity (B 0,015; p 0,01) were maintained. Moreover, we found an inverse association with biological disease-modifiying antirheumatic drugs (B-4,69; p 0,048), specifically with anti-tumoral necrosis factor α (antiTNFα) (B -4,7; p 0,042)ConclusionsHypovitaminosis D prevalence in our population is similar to previously described.JIA patients with higher BMIp have more hypovitaminosis D, as it has been reported in other inflammatory diseases.A direct relationship exists between inflammatory activity and vitamin D, but we need more studies to asses if one is cause or consecuence of the other.Patients treated with antiTNF have better plasma levels of 25 hydroxy-vitamin D, this can be explained because these drugs may increase 25 hydroxy-vitamin D levels or due to a better response to antiTNF of those patient with higher plasma levels of 25 hydroxy-vitamin D.References Nisar MK, Masood F, Cookson P, Sansome A, Östör AJ. What do we know about juvenile idiopathic arthritis and vitamin D? A systematic literature review and meta-analysis of current evidence. Clin Rheumatol 2013; 32:729–734.Santos-Antunes J, Corte-Real Nunes A, Lopes S, Macedo G. The Relevance of Vitamin D and Antinuclear Antibodies in Patients with Inflammatory Bowel Disease Under Anti-TNF Treatment: A Prospective Study. Inflamm Bowel Dis 2016;22:1101–1106.Ham M, Longhi MS, Lahiff C, Cheifetz A, Robson S, Moss AC. Vitamin D levels in adults with Crohn's disease ar...

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