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

Abstract

Summary The outbreak of chilblain‐like lesions (CLL) coincidentally to the COVID‐19 pandemic is a topic of great concern. SARS‐CoV‐2 was initially hypothesized as the etiologic agent of CLL, but, since nasopharyngeal swabs seldom resulted positive, dermatologists’ attention focused on the search for specific SARS‐CoV‐2 antibodies. Many papers were published contemporarily on this topic, reporting limited case series. We reviewed the English literature up to the 1 st July 2020 and, excluding single case reports, we considered 13 studies that serologically investigated 220 patients. The presence of specific antibodies was detected in 18 subjects (8,2%): isolated IgA were found in 6 patients, IgA and IgG in 1, isolated IgG in 5, and IgM in 2. In 4 patients, isotypes were not specified. Our review demonstrated a high prevalence of negative serological results in CLL: antibodies were observed only in a few patients, that are even less excluding those with positive IgA, not clearly involved in the pathogenesis of the disease. In conclusion, although it is still uncertain whether CLL are related to SARS‐CoV‐2 infection, patients affected by CLL seem not to be prone to shedding the virus, hence, if they are asymptomatic, we can reassure them, thus avoiding hospital referral This article is protected by copyright. All rights reserved.

Chilblains in a child with confirmed SARS‐CoV‐2 infection: a red flag for late‐onset skin manifestation in previously infected individuals

“…There has been a wide controversy about the causal relation between COVID-19 and CLL as many patients do not show other symptoms and RT-PCR tests from skin specimens and even serological studies are often negative. 2,[5][6][7][8] Attending to the results of our study, IgG antibodies against SARS-CoV-2 appear to be indeed a risk factor for CLL that overall occur in asymptomatic or mildly symptomatic patients, as none of the patients required hospitalization. It should be noted that more than half of the cases were seronegative.…”

“…Editor Chilblain-like lesions (CLL) were described early on the coronavirus disease 2019 (COVID-19) pandemic as red-to-violet macules, plaques or nodules typically appearing at the distal aspects of toes. 1 Although increasing evidence suggests they are COVID-19-related, 2 it is not supported by analytic controlled studies.…”

“…The relationship with SARS-CoV-2 infection is still debated. [1][2][3] Emerging literature regarding this possible correlation focuses on two hypotheses: an endothelial infection or the result of an IFN type I-mediated immune response. 4,5 We present the case of a 6-year-old girl with confirmed mild COVID-19 and late-onset chilblains.…”

Chilblains and COVID‐19: can recent epidemiological data shed light on the aetiological debate?

“…The physiopathology of these chilblains has not been completely elucidated and their direct link to COVID‐19 remains unconfirmed and debated 1 . Reverse transcription (RT)‐PCR on nasopharyngeal swabs and anti‐SARS‐CoV‐2 antibodies were negative in most patient series reported 2 . Lifestyle changes associated with lockdown, notably increased sedentariness and prolonged barefoot exposure to cold floors, in predisposed subjects (a high number of patients with antinuclear antibodies positivity and low body mass index) could be a possible explanation for this outbreak of chilblains 3,4 .…”

Snotwatch COVID-Toes: An ecological study of chilblains and COVID-19 diagnoses in Victoria, Australia

“…While an international register of people with skin eruptions revealed 45% of 505 patients had respiratory symptoms consistent with COVID-19, 8 other studies found no serological evidence of COVID-19 infection in people with chilblains. 9 Given the difficulty synthesising these contradictory findings, we aimed to establish and quantify the temporal relationship of chilblains with COVID-19 in Victoria, Australia in an ecological framework. Using such a large dataset lays the groundwork for future research and has substantial public health and epidemiological implications for tracking COVID-19 viral spread in the community.…”