Chilblains-Like Lesions in Pediatric Patients: A Review of Their Epidemiology, Etiology, Outcomes, and Treatment

Abstract

Vascular pathologies associated with SARS-CoV-2 infection are poorly understood. Color and sensory changes to the extremities, often referred to as “COVID toes” or chilblains-like lesions, have been widely reported in children and adolescents since the onset of the pandemic, raising the concern that they could be a vasculitis secondary to the infection. However, it is unclear if the lesions are a result of the infection or an epiphenomenon. Most literature focuses on adults, and while there are reports on children and adolescents, many of them are small. This review will help medical care providers better understand the epidemiology, etiology, outcomes, and potential treatments for chilblains-like lesions seen in children and adolescents during the pandemic.

The Characteristics of Patients With COVID‐19–Associated Pediatric Vasculitis: An International, Multicenter Study

“…Chilblains were more frequent in children during the pandemic compared to the pre‐pandemic era ( 20 , 21 , 22 ). In a recent literature review, it was reported that 1,059 children developed chilblain‐like lesions that were likely associated with COVID‐19 ( 21 ).…”

“…Chilblains were more frequent in children during the pandemic compared to the pre‐pandemic era ( 20 , 21 , 22 ). In a recent literature review, it was reported that 1,059 children developed chilblain‐like lesions that were likely associated with COVID‐19 ( 21 ). The more frequent occurrence of these lesions during late childhood to early adolescence and a male predominance were the striking common features in these reports ( 21 ).…”

“…In a recent literature review, it was reported that 1,059 children developed chilblain‐like lesions that were likely associated with COVID‐19 ( 21 ). The more frequent occurrence of these lesions during late childhood to early adolescence and a male predominance were the striking common features in these reports ( 21 ). There were only 2 adolescent girls with COVID‐19–associated chilblains in our cohort, since we included only patients with a histopathologic verification of vasculitis.…”

Child with swollen fingers associated with recent SARS‐CoV‐2 infection

“…systemic lupus erythematosus) or immunological (e.g. Aicardi‐Goutières) condition 1 . Although this patient had a positive anti‐nuclear antibody, the titre was low positive and he was otherwise well.…”

“…Aicardi-Goutières) condition. 1 Although this patient had a positive anti-nuclear antibody, the titre was low positive and he was otherwise well. An underlying rheumatological condition was considered unlikely.…”