Approach to Chilblains During the COVID-19 Pandemic

Abstract

Coronavirus disease (COVID-19) chilblains is a well-reported cutaneous pattern of severe acute respiratory syndrome coronavirus (SARS-CoV-2). Through this narrative review, we provide an evidence-based overview of idiopathic and secondary chilblains, distinguishing features of COVID-19 chilblains, and a systematic clinical approach to history, examination, investigations, and treatment. In the absence of cold or damp exposure, COVID-19 should be considered as a cause of acute chilblains. The timing of onset of COVID-19 chilblains relative to active SARS-CoV-2 viremia remains unclear. Patients with suspected COVID-19 chilblains should thus follow public health guidelines for COVID-19 testing and self-isolation.

Clinical Characteristics and Transmission of COVID-19 in Children and Youths During 3 Waves of Outbreaks in Hong Kong

“…15 Although the exact pathophysiology of chilblains in individuals with COVID-19 remains to be elucidated, possible mechanisms include an abnormal inflammatory response attributed to type I interferonopathies or thrombotic microvasculature induced by complement activation and procoagulation state. 16 Another unique manifestation of COVID-19 was MIS-C, with features resembling those of Kawasaki disease, which developed 4 weeks after diagnosis of the infection in a patient who was not Chinese. However, no other Hong Kong Chinese individuals with COVID-19 developed MIS-C. Globally, the first case of MIS-C as a complication of pediatric COVID-19 was reported in Europe.…”

Skin Manifestations Associated with COVID-19: Current Knowledge and Future Perspectives

“…In the absence of definitive data on chilblain-like acral lesions’ pathogenesis, the occurrence of such lesions should prompt self-isolation and confirmatory testing for SARS-CoV-2 infection [65].…”

Reader Comment Regarding “Approach to Chilblains During the COVID-19 Pandemic”

“…In this context, we have read with interest the article entitled "Approach to chilblains during the COVID-19 pandemic" recently reported by Ladha in the Journal. 4 The authors propose an algorithm for the etiological diagnosis of chilblains in the COVID-19 era. This algorithm differentiates between primary COVID-19 chilblains and other causes, including idiopathic chilblains, cryoproteinemias, autoimmune conditions, and hematologic dyscrasias, among others.…”