BackgroundDifferent skin manifestations of COVID‐19 are being reported. Acral lesions on the hands and feet, closely resembling chilblains, have been recognized during the peak incidence of the COVID‐19 pandemic.Material and methodsA retrospective review of 22 children and adolescents with chilblain‐like lesions seen over a short period of time in the Emergency Department of a children's hospital during the peak incidence of COVID‐19 in Madrid, Spain.ResultsAll patients had lesions clinically consistent with chilblains of the toes or feet, with three also having lesions of the fingers. Pruritus and mild pain were the only skin symptoms elicited, and only 10 had mild respiratory and/or GI symptoms. None had fever. Coagulation tests, hemogram, serum chemistry, and lupus anticoagulant were normal in all patients tested. One out of 16 tested cases had elevated D‐dimer results, but without systemic symptoms or other laboratory anomalies. SARS‐CoV‐2 PCR tested in 19 cases was positive in just one case. Skin biopsies obtained in six patients were consistent with chilblains. On follow‐up, all cases showed spontaneous marked improvement or complete healing.ConclusionAcute chilblains were observed during COVID‐19 pandemic in children and teenagers. It is a mildly symptomatic condition with an excellent prognosis, usually requiring no therapy. Etiopathogenesis remains unknown.
Skin manifestations including urticarial, morbilliform, vesicular and petechial exanthems, and vasospastic manifestations such as livedo reticularis and acral ischemic lesions 1-5 have been reported in association with coronavirus disease 2019 (COVID-19). In particular, chilblains on the feet and hands have being extensively documented worldwide during the peak incidence of the pandemic. [6][7][8] During our examination of 22 cases of chilblains in children and adolescents, 9 we identified four patients who also showed skin lesions similar to erythema multiforme. We report these cases and discuss their clinical and histopathologic features, as well as the possible relationship to COVID-19.
Background The COVID‐19 pandemic has brought innumerable reports of chilblains. The relation between pernio‐like acral eruptions and COVID‐19 has not been fully elucidated because most reported cases have occurred in patients with negative microbiological tests for SARS‐CoV‐2. Methods A retrospective study of 49 cases of chilblains seen during the first year of the pandemic in a children's hospital in Madrid, Spain. The incidence of these skin lesions was correlated with the number of COVID‐19 admissions and environmental temperatures. Patients were separated into two groups depending on the day of onset (strict lockdown period vs. outside the lockdown period). Results Most chilblains cases presented during the first and third waves of the pandemic, paralleling the number of COVID‐19 admissions. The first wave coincided with a strict lockdown, and the third wave coincided with the lowest ambient seasonal temperatures of the year. Systemic symptoms preceding chilblains were more frequent in the first wave (45.8% vs. 8.0%, p = .002), as was the co‐occurrence with erythema multiforme‐like lesions (16.7% vs. 0%, p = .033). Laboratory test and skin biopsies were performed more frequently in the first wave (75.0% vs. 12.0%, p < .001; and 25.0% vs. 0%, p = .007; respectively). Five patients developed recurrent cutaneous symptoms. Conclusions An increased incidence of chilblains coincided not only with the two major waves of the pandemic, but also with the strict lockdown period in the first wave and low seasonal temperatures during the third wave. Both increased sedentary behaviors and cold environmental temperatures may have played an additive role in the development of COVID‐19‐related chilblains.
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