Acral Changes in pediatric patients during COVID 19 pandemic: Registry report from the COVID 19 response task force of the society of pediatric dermatology (SPD) and pediatric dermatology research alliance (PeDRA)
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“…Also, laboratory investigations were progressively abandoned since all patients tested earlier in the pandemic had not shown any relevant abnormality. Coinciding with the largest registry of pediatric COVID patients published to date by Castello-Socio et al, children with acral pernio-like changes in our series were healthy and all recovered with no short-term sequelae 14. Relapsing of chilblains in otherwise previously healthy children has already been documented.…”
supporting
confidence: 69%
“…Coinciding with the largest registry of pediatric COVID patients published to date by Castello‐Socio et al, children with acral pernio‐like changes in our series were healthy and all recovered with no short‐term sequelae. 14 …”
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.
“…Also, laboratory investigations were progressively abandoned since all patients tested earlier in the pandemic had not shown any relevant abnormality. Coinciding with the largest registry of pediatric COVID patients published to date by Castello-Socio et al, children with acral pernio-like changes in our series were healthy and all recovered with no short-term sequelae 14. Relapsing of chilblains in otherwise previously healthy children has already been documented.…”
supporting
confidence: 69%
“…Coinciding with the largest registry of pediatric COVID patients published to date by Castello‐Socio et al, children with acral pernio‐like changes in our series were healthy and all recovered with no short‐term sequelae. 14 …”
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.
“…In four cases, resolution occurred by day 6, in 47 cases it occurred between 7 to 20 days, and in 80 cases, it occurred after 21 days (11, 13, 17, 19, 22, 23, 25, 26, 28, 29, 33-36, 43, 44, 48, 53). A large study of 378 cases reported lesions resolving an average of 21.6 days after onset, though the median time to resolution was 14 days (11). Other reported outcomes included the following: a majority of 71 cases had a median resolution time of 47 days, 19 cases resolved between 14 and 30 days, 17 cases resolved after a mean of 27 days, eight cases had resolution by a median of 7 days, and seven cases resolved by 8 weeks (12,14,18,37,48).…”
Vascular pathologies associated with SARS-CoV-2 infection are poorly understood. Color and sensory changes to the extremities, often referred to as “COVID toes” or chilblains-like lesions, have been widely reported in children and adolescents since the onset of the pandemic, raising the concern that they could be a vasculitis secondary to the infection. However, it is unclear if the lesions are a result of the infection or an epiphenomenon. Most literature focuses on adults, and while there are reports on children and adolescents, many of them are small. This review will help medical care providers better understand the epidemiology, etiology, outcomes, and potential treatments for chilblains-like lesions seen in children and adolescents during the pandemic.
“…The phenotype of cool extremities with pain/swelling, followed by red-violaceous discoloration and finally vesiculation of the toes and fingers were strikingly consistent ( Figure 1 a). Whereas older age was an important risk factor for severe infection, most patients with pernio were young, with a median age of 25 years in an international dermatology registry ( Castelo-Soccio et al 2021 ; Freeman et al 2020 ). Many had close contact with COVID-19 infected individuals, yet nearly all were otherwise healthy and denied typical respiratory manifestations of COVID-19 ( Castelo-Soccio et al 2021 ; Freeman et al 2020 ).…”
mentioning
confidence: 99%
“…Whereas older age was an important risk factor for severe infection, most patients with pernio were young, with a median age of 25 years in an international dermatology registry ( Castelo-Soccio et al 2021 ; Freeman et al 2020 ). Many had close contact with COVID-19 infected individuals, yet nearly all were otherwise healthy and denied typical respiratory manifestations of COVID-19 ( Castelo-Soccio et al 2021 ; Freeman et al 2020 ). The spatial and temporal association between pernio and the COVID-19 pandemic has now been independently observed across multiple countries including Italy, Spain, Germany, the UK, France, and the U.S. Figure 1 Pandemic-Associated Pernio presentation and histopathology.…”
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