Chilblains in children in the setting of COVID‐19 pandemic

Abstract

BackgroundDifferent skin manifestations of COVID‐19 are being reported. Acral lesions on the hands and feet, closely resembling chilblains, have been recognized during the peak incidence of the COVID‐19 pandemic.Material and methodsA retrospective review of 22 children and adolescents with chilblain‐like lesions seen over a short period of time in the Emergency Department of a children's hospital during the peak incidence of COVID‐19 in Madrid, Spain.ResultsAll patients had lesions clinically consistent with chilblains of the toes or feet, with three also having lesions of the fingers. Pruritus and mild pain were the only skin symptoms elicited, and only 10 had mild respiratory and/or GI symptoms. None had fever. Coagulation tests, hemogram, serum chemistry, and lupus anticoagulant were normal in all patients tested. One out of 16 tested cases had elevated D‐dimer results, but without systemic symptoms or other laboratory anomalies. SARS‐CoV‐2 PCR tested in 19 cases was positive in just one case. Skin biopsies obtained in six patients were consistent with chilblains. On follow‐up, all cases showed spontaneous marked improvement or complete healing.ConclusionAcute chilblains were observed during COVID‐19 pandemic in children and teenagers. It is a mildly symptomatic condition with an excellent prognosis, usually requiring no therapy. Etiopathogenesis remains unknown.

Cutaneous manifestations associated with COVID-19 in children: A Systematic Review

“…Acrally located erythematous to violaceous maculopapular lesion having blurred edges, occasionally with super cial bullae and focal hemorrhagic crust was the most common nding in 127 children. [16], [20], [24], [25], [26] A similar but larger lesion as erythematous to purpuric plaques with occasional macules was reported in 11 cases. [16], [19] [21], [27] Erythema multiforme like lesion observed in 6 cases, consisted of target and targetoid, con uent macules, papules and plaques of different sizes, few with bleeding and crust at the center with the involvement of conjunctiva in one and mucous membrane in one patient each.…”

“…The varied cutaneous presentations, histopathological ndings, and other details are tabulated in table 3. Reference [16], [19], [20], [21], [24], [25], [26], [27] [17], [18], [ The majority of the children showed erythematous maculopapular eruptions, which is generally the commonest cutaneous presentation in any viral illness, however, a closer look in our study subjects throws up several contradicting observations. For instance, instead of general cephalocaudal distribution in any viral exanthem, here the cases showed involvement of acral region of feet and hands.…”

“…Out of that 5 were case series, [16], [17] [18], [19] [20] 4 were case reports, [21], [22] [23], [24] and 4 were original studies. [25], [26] [27], [28] Maximum number of articles were reported from Italy, [16], [19] [20], [21] [22], [24] [26] followed by Spain, [17] [23], [25] France, [8] Turkey, [28] and USA. [27] All studies were published during April &May 2020.…”

“…Further Andina et al mentioned in their study that 22 children reported a median of 7days with a range of 1-28 days. [25] Systemic manifestations like fever, upper respiratory tract infection (URI) and Gastro Intestinal (GI) symptoms were present in 11, 20, and 22 cases respectively. Upper respiratory tract infection (URI) in the form of mild u & rhinorrhea while GI symptoms included loss of taste, diarrhea, nausea & vomiting.…”

Perniosis during the COVID‐19 pandemic: Negative anti‐SARS‐CoV‐2 immunohistochemistry in six patients and comparison to perniosis before the emergence of SARS‐CoV‐2

“…Skin findings resembling perniosis or chilblains, most commonly affecting children's toes, have been reported from geographic areas where COVID-19 has been prevalent. [1][2][3][4] Soles and heels, as well as fingers, 4,5 can be involved. 1,3,6 Affected individuals may manifest mild fever or respiratory symptoms in the weeks preceding the skin lesions.…”