Acute acral cutaneous manifestations during the COVID‐19 pandemic: a single‐centre experience

Abstract

Coronavirus disease 2019 (COVID‐19), caused by severe acute respiratory syndrome‐related coronavirus 2 (SARS‐CoV‐2), was first reported in China on December 2019. Almost 5 months into the pandemic, little is still known about cutaneous manifestations in COVID‐19. In fact, the prevalence of cutaneous signs varies greatly in the literature, ranging from 0.2% to 20.4%. Given their potential association with COVID‐19, acral lesions have received special attention worldwide, both in the medical literature and the media. Our aim is to share our experience regarding acral manifestations during this pandemic.

Do we have serological evidences that chilblain‐like lesions are related to SARS‐CoV ‐2? A review of the literature

“…Moreover, mean European temperatures during the first months of 2020 were similar or higher compared to those of the last 29 years, and solely the sedentary habits and barefoot walking at home seem inadequate to justify an epidemic of CLL. Serological tests are not reliable: This was particularly true with the initially‐available tests, since they had been rapidly developed and placed on the market with limited validation. However, we can exclude this hypothesis because serological tests showed excellent clinical performance in real life 1 and the authors used eight different types of test, achieving similar findings. Patients with mild disease tend not to have an adequate antibody response: Higher levels of IgM and IgG have been found in the second and third week of illness, then IgM begins to decline and almost disappears by week 7, while IgG persists 12,13 . The duration of their persistence still remains unknown: data suggest a serological profile similar to SARS‐CoV, 12 although asymptomatic/paucisymptomatic patients seem to present lower levels of specific antibodies compared to severe disease.…”

“…Patients with mild disease tend not to have an adequate antibody response: Higher levels of IgM and IgG have been found in the second and third week of illness, then IgM begins to decline and almost disappears by week 7, while IgG persists 12,13 . The duration of their persistence still remains unknown: data suggest a serological profile similar to SARS‐CoV, 12 although asymptomatic/paucisymptomatic patients seem to present lower levels of specific antibodies compared to severe disease.…”

COVID toes: where do we stand with the current evidence?

“…( Baeck et al, 2020c , Ko et al, 2020 ). Conversely, RT-PCR and anti-SARS-CoV-2 serology were mostly negative ( Herman et al, 2020 , Baeck et al, 2020a , Caselli et al, 2020 , El Hachem et al, 2020 , Neri et al, 2020 , Roca-Ginés et al, 2020 , Rouanet et al, 2020 , Rizzoli et al, 2020 , Mahieu et al, 2020 , García-Legaz Martínez et al, 2020 , Garcia-Lara et al, 2020 , Freeman et al, 2020b , Colonna et al, 2020 , Le Cleach et al, 2020 , Lesort et al, 2020 , Stavert et al, 2020 , Denina et al, 2020 ). Negative RT-PCR on nasopharyngeal swabs could suggest that chilblains are a late symptom of COVID-19.…”

Dermatologic manifestations of COVID‐19: a comprehensive systematic review

“…A cohort study from France had enrolled 759 PCR+ COVID‐19 patients, of which eight (1%) developed skin manifestations which were classified as an erythematous maculopapular rash 29 . Studies from the international registry, 5 France, 8,19 Italy, 20 and Spain 14 described in the pernio‐like subsection also reported between two and 17 cases of erythematous rash. For three of these studies described earlier, 13,15,21 the most common cutaneous manifestation amongst the cohort was a maculopapular erythematous rash, with 29 of 52, 14 of 33, and 176 of 375 respectively.…”

“…Within smaller cohorts, 14,15,19–21,36,37 there were between one and seven reported cases of urticaria. Larger studies of over 300 patients found several patients with urticaria as well.…”