Chilblain‐like lesions in pediatrics dermatological outpatients during the COVID ‐19 outbreak

Abstract

In Spain, with full confinement measures and coinciding with the pandemic, pediatricians and dermatologists have received, through teledermatology/teleconsultation and social networks, a barrage of diverse images, which have subsequently allowed us to approach some of them by direct physical examination of early and late skin manifestations associated with SARS-Cov-2 infection. We designed a retrospective, cross-sectional study to evaluate the dermatological care of all those patients under the age of 16 who consulted, in person or telematically, for acral lesions (chilblain-like or erythema multiforme-like) in the context of the Coronavirus disease (COVID-19) pandemic, since 15 March 2020 to 24 April 2020, both included in the health area of the Hospital Universitario San Cecilio de Granada. Of all the patients collected, 18 (66%) were male and the overall mean age was 14.44 years. All lacked a personal history of interest and denied previous episodes of chilblains or Raynaud's phenomenon/disease. The clinic was limited to purpuric lesions located on acral regions distributed on hands and feet. Dermatologists and pediatricians should be aware of the lesions associated with COVID-19 infection and their possible complications. It remains to be identified if there are different dermatological patterns in the pediatric and adult population.

Cutaneous Manifestations of COVID-19: A Systematic Review

“…11,15,[34][35][36] These vascular lesions were commonly identified among adolescents and young adults. 11,15,34,35,[37][38][39][40][41][42][43] Anatomical locations of chilblain-like lesions were consistent between studies with feet and hands being affected the most often. On the hands and feet, the acral lesions would typically localize on the fingers and toes, respectively.…”

High prevalence of cryofibrinogenemia in patients with chilblains during the COVID‐19 outbreak

“…5 Alternatively, these lesions could constitute a late manifestation of the disease, and therefore, the virus may not be detectable at the time of performing the test. 5,14,15 Regarding serological tests, some authors have proposed that negative results in patients with chilblains related to SARS-COV-2 could be because of lack of novel techniques' sensitivity. 16,17 Another possible explanation for the lack of serologically positive results in our series and other reports could be that children have strong innate immune response owing to trained immunity (secondary to livevaccines and frequent viral infections), leading to probably early control of infection at the site of entry.…”

Cutaneous signs in COVID ‐19 patients: A review

“…Mild pain (22%) or pruritus (11%) were the associated symptoms. The lesions disappeared within 2 weeks without treatment 20 . From Lombardy, 14 cases including 11 children (average age 14 years) and 3 young adults (average age 29 years) with chilblain‐like eruptions were reported.…”