Acro‐ischaemia in hospitalized COVID‐19 patients

Suárez‐Valle, Ana; Fernández‐Nieto, Diego; Díaz‐Guimaraens, Borja; Dominguez‐Santás, Miguel; Carretero, Isabel; Pérez‐García, B.

doi:10.1111/jdv.16592

Cited by 38 publications

(48 citation statements)

References 14 publications

(18 reference statements)

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“…[7][8][9] In addition to vesicular or maculopapular skin rashes, livedoid/necrotic lesions and urticaria, chilblainslike lesions are increasingly reported in particular in adolescents and young adults. [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] We also observed from last March an unusual number of patients, mainly teenagers, affected with chilblains-like lesions. Thus, we decided to investigate the aetiology of these lesions and possible relationship with COVID-19 infection in our patients.…”

Section: Introductionmentioning

confidence: 53%

“…Chilblain-like lesions are being increasingly reported in different European and non-European countries during COVID-19 pandemic. [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] Indeed, first case series on skin manifestations during COVID-19 outbreak indicate that acral lesions are quite frequent: they were present in 106 of 277 dermatological outpatients (38.3%) in a French retrospective study 22 and in 79 of 375 cases (21%) in a Spanish prospective survey. 9 Therefore, we decided to undertake a systematic study of clinical, capillaroscopic, histopathological and SARS-CoV-2 infection in paediatric patients referred to us for this peculiar skin manifestation, in order to investigate a possible relationship with COVID-19 infection.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A clinical, histopathological and laboratory study of 19 consecutive Italian paediatric patients with chilblain‐like lesions: lights and shadows on the relationship with COVID‐19 infection

Hachem

Diociaiuti

Concato

et al. 2020

Acad Dermatol Venereol

123

221

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Background Acral chilblain-like lesions are being increasingly reported during COVID-19 pandemic. However, only few patients proved positivity for SARS-CoV-2 infection. The relationship between this skin manifestation and COVID-19 infection has not been clarified yet. Objective To thoroughly characterize a prospective group of patients with chilblain-like lesions and to investigate the possible relationship with SARS-CoV-2 infection. Methods Following informed consent, patients underwent (i) clinical evaluation, (ii) RT-PCR and serology testing for SARS-CoV-2, (iii) digital videocapillaroscopy of finger and toe nailfolds, (iv) blood testing to screen for autoimmune diseases and coagulation anomalies, and (v) skin biopsy for histopathology, direct immunofluorescence and, in selected cases, electron microscopy. Results Nineteen patients, all adolescents (mean age: 14 years), were recruited. 11/19 (58%) of them and/or their cohabitants reported flu-like symptoms one to two months prior to skin manifestation onset. Lesions were localized to toes and also heels and soles. Videocapillaroscopy showed pericapillary oedema, dilated and abnormal capillaries, and microhaemorrhages both in finger and toe in the majority of patients. Major pathological findings included epidermal basal layer vacuolation, papillary dermis oedema and erythrocyte extravasation, perivascular and perieccrine dermal lymphocytic infiltrate, and mucin deposition in the dermis and hypodermis; dermal vessel thrombi were observed in two cases. Blood examinations were normal. Nasopharyngeal swab for SARS-CoV-2 and IgG serology for SARS-CoV-2 nucleocapsid protein were negative. Importantly, IgA serology for S1 domain of SARS-CoV-2 spike protein was positive in 6 patients and borderline in 3. Conclusions Chilblain-like lesions during COVID-19 pandemic have specific epidemiologic, clinical, capillaroscopic and histopathological characteristics, which distinguish them from idiopathic perniosis. Though we could not formally prove SARS-CoV-2 infection in our patients, history data and the detection of anti-SARS-COV-2 IgA strongly suggest a relationship between skin lesions and COVID-19. Further investigations on the mechanisms of SARS-CoV-2 infection in children and pathogenesis of chilblain-like lesions are warranted.

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Section: Introductionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 99%

A clinical, histopathological and laboratory study of 19 consecutive Italian paediatric patients with chilblain‐like lesions: lights and shadows on the relationship with COVID‐19 infection

Hachem

Diociaiuti

Concato

et al. 2020

Acad Dermatol Venereol

123

221

View full text Add to dashboard Cite

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“…Indeed, in a recent study of COVID-19 patients admitted to the intensive care unit, all participants with high levels of D-dimer, fibrinogen and fibrinogen degradation products, developed finger/toe cyanosis, skin bulla, and dry gangrene [120]. Similarly, in three hospitalized patients with pneumonia associated with SARS-CoV-2 infection from Madrid, Spain, acro-ischemia in toes was documented after 17-28 days of admission [94]. Finally, two individuals from a French cohort of COVID-19 patients showed necrotic and non-necrotic purpura [12].…”

Section: Acro Ischemia and Livedoid Lesionsmentioning

confidence: 99%

Dermatological aspects of SARS-CoV-2 infection: mechanisms and manifestations

2020

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The human infection caused by the novel SARS-CoV-2 is a public health emergency of international concern. Although the disease associated to this virus, named COVID-19, mainly affects the lungs, the infection can spread to extrapulmonary tissues, causing multiorgan involvement in severely ill patients. The broad infective capacity of SARS-CoV-2 is related to the pattern of expression of the viral entry factors ACE2 and TMPRSS2 in human tissues. As such, the respiratory and gastrointestinal tracts are at high risk for SARS-CoV-2 infection due to their high expression of ACE2 and TMPRSS2, which explains the clinical phenotype described in the vast majority of infected patients that includes pneumonia and diarrhea. Recently, preoccupation about the potential of the virus to infect the skin has been raised by dermatologists due to the increasing observations of cutaneous manifestations in patients with SARS-CoV-2 infection. Although there is little evidence of the expression of ACE2 and TMPRSS2 in the normal skin, the dermatological findings observed among COVID-19 patients warrants further investigation to delineate the mechanisms of skin affection after SARS-CoV-2 infection. Here, we provide a summary of the dermatological findings observed among patients with laboratory-confirmed SARS-CoV-2 infection based on recent reports. In addition, we analyze possible mechanisms of skin injury in COVID-19 patients and discuss about the risk of individuals with chronic skin conditions for SARS-CoV-2 infection. The present review constitutes a useful informative tool to improve our understanding of the pathophysiological mechanisms of COVID-19 and the possible implications of the current pandemic in dermatology.

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“…Recalcati first reported the presence of cutaneous manifestation in COVID-19 (5). Since then, a few case reports (5)(6)(7)(8)(9) and case series (10) have identified a range of potential dermatological manifestations of COVID-19 in adults. Similarly, in case reports (11)(12)(13)(14)(15), children who complained about skin rashes became COVID-19 positive.…”

Section: Contextmentioning

confidence: 99%

“…These lesions could be found in children with few symptoms (7,11,14) and the adult patients. They might have elevated D-dimer and deranged coagulation profile, which may be the expression of microthrombosis due to endothelial damage and vascular abnormalities (9).…”

Section: Cutaneous Manifestations In Children During Covid-19mentioning

confidence: 99%

Dermatological Manifestations of COVID-19 in Children

Athwani

Gothwal

2020

J Skin Stem Cell

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: Coronavirus infection 2019 (COVID-19) primarily has a respiratory system and multi-systemic involvement. Respiratory and gastrointestinal symptoms are predominantly seen in children. In adults, few COVID-19 cases are reported with cutaneous manifestations. Although children are less severely affected by COVID-19, there is increasing evidence for skin involvement, which is in the form of chilblain (e.g., lesions, vesicular, and maculopapular) and erythema multiforme (e.g., rash). Also, few COVID-19 cases are presented with a clinical picture of atypical Kawasaki disease and toxic shock syndrome, later defined as pediatric multisystem inflammatory syndrome (PMIS). The present study aims to summarize various skin lesions with COVID-19.

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Acro‐ischaemia in hospitalized COVID‐19 patients

Cited by 38 publications

References 14 publications

A clinical, histopathological and laboratory study of 19 consecutive Italian paediatric patients with chilblain‐like lesions: lights and shadows on the relationship with COVID‐19 infection

A clinical, histopathological and laboratory study of 19 consecutive Italian paediatric patients with chilblain‐like lesions: lights and shadows on the relationship with COVID‐19 infection

Dermatological aspects of SARS-CoV-2 infection: mechanisms and manifestations

Dermatological Manifestations of COVID-19 in Children

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