Frequency of relapse and persistent cutaneous symptoms after a first episode of chilblain‐like lesion during the COVID‐19 pandemic

Moghadam, Parna; Frumholtz, L.; Jaume, Léa; Masson, Adèle de; Bégon, É.; Sulimovic, L.; Petit, Antoine; Bachelez, Hervé; Bagot, M.; Bouaziz, Jean‐David; Cassius, C.; Archer, Gordon L.; Benattia, A.; Bergeron, Amanda; Bondeelle, Louise; Bouda, D.; Boutboul, David; Berthon, I. Brindel; Bugnet, Emmanuelle; Zucman, S. Caillat; Cassonnet, S.; Lebras, Karine Celli; Chabert, Jacqueline; Chevret, Sylvie; Clément, Marina; Davoine, Claire; Castro, N de; Kerviler, É. de; Margerie-Mellon, Constance de; Delaugerre, Constance; Dépret, François; Denis, Blandine; Djaghout, Lalia; Dupin, Clarisse; Farge‐Bancel, Dominique; Fauvaux, Catherine; Feredj, E.; Feyeux, Delphine; Fontaine, J.-P.; Frémeaux‐Bacchi, Véronique; Galicier, Lionel; Harel, Stéphanie; Jegu, Anne Lise; Kozakiewicz, E.; Lebel, MH; Baye, Ariane; Goff, Jérôme Le; Guen, Pierre Le; Lengliné, Étienne; Liégeon, Geoffroy; Lorillon, Gwenaël; Chambrin, I. Madelaine; Frémont, Grégoire Martin de; Meunier, Marie; Molina, Jean‐Michel; Morin, François; Oksenhendler, Éric; Tour, Régis Peffault de la; Peyrony, Olivier; Plaud, Benoît; Salmona, Maud; Saussereau, Julien; Soret, Juliette

doi:10.1111/jdv.17393

Cited by 13 publications

(17 citation statements)

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“…The relationship between SARS-CoV-2 infection and CLL is still controversial; however, recurrence of previous chilblain lesions during the second wave of COVID-19 and peaks of CLLs concomitant with peaks of COVID-19 deaths in 2020 18,19 strongly suggest that this disorder is closely related to SARS-CoV-2 infection. 20 In our study, SARS-CoV-2 assays were almost all negative except for four serology results at day 0.…”

Section: Discussionmentioning

confidence: 99%

“…The median duration between suggestive extracutaneous symptoms (when present) and CLL was 7 days [interquartile range (IQR) 2 -16]. The median duration between suggestive extracutaneous symptoms and study inclusion was 24 days (IQR [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. The median duration between onset of CLL and study inclusion was 15 days (IQR 10-21).…”

Section: Patient Characteristicsmentioning

confidence: 99%

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Type I interferon response and vascular alteration in chilblain‐like lesions during the COVID‐19 outbreak*

et al. 2021

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Summary Background The outbreak of chilblain‐like lesions (CLL) during the COVID‐19 pandemic has been reported extensively, potentially related to SARS‐CoV‐2 infection, yet its underlying pathophysiology is unclear. Objectives To study skin and blood endothelial and immune system activation in CLL in comparison with healthy controls and seasonal chilblains (SC), defined as cold‐induced sporadic chilblains occurring during 2015 and 2019 with exclusion of chilblain lupus. Methods This observational study was conducted during 9–16 April 2020 at Saint‐Louis Hospital, Paris, France. All patients referred with CLL seen during this period of the COVID‐19 pandemic were included in this study. We excluded patients with a history of chilblains or chilblain lupus. Fifty patients were included. Results Histological patterns were similar and transcriptomic signatures overlapped in both the CLL and SC groups, with type I interferon polarization and a cytotoxic–natural killer gene signature. CLL were characterized by higher IgA tissue deposition and more significant transcriptomic activation of complement and angiogenesis factors compared with SC. We observed in CLL a systemic immune response associated with IgA antineutrophil cytoplasmic antibodies in 73% of patients, and elevated type I interferon blood signature in comparison with healthy controls. Finally, using blood biomarkers related to endothelial dysfunction and activation, and to angiogenesis or endothelial progenitor cell mobilization, we confirmed endothelial dysfunction in CLL. Conclusions Our findings support an activation loop in the skin in CLL associated with endothelial alteration and immune infiltration of cytotoxic and type I IFN‐polarized cells leading to clinical manifestations.

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Section: Discussionmentioning

confidence: 99%

Section: Patient Characteristicsmentioning

confidence: 99%

Type I interferon response and vascular alteration in chilblain‐like lesions during the COVID‐19 outbreak*

et al. 2021

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“…Several issues remain regarding the relationship between chilblains and SARS-CoV-2. Among them, one can wonder whether SARS-CoV-2 exposure acts as a stimulus for a flare (a first or a subsequent one) among subjects with an immuno-genetic background predisposing to chilblains, or whether SARS-CoV-2 is an independent cause of chilblains; whether any other clusters of chilblains have occurred following anti-SARS-CoV-2 vaccination, since 8 cases have been reported in a registry-based study [ 26 ]; and on practical grounds, what is the medium-to-long term evolution of patients with chilblains occurring during the first lockdown, given that persistent symptoms following COVID-19 are increasingly being described [ [27] , [28] , [29] , [30] , [31] , [32] , [33] ]. Persistent systemic and acral manifestations among the individuals with chilblains included in this study have been described in another article [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

Chilblains during lockdown are associated with household exposure to SARS-CoV-2: a multicentre case–control study

Poizeau

Oger²,

Barbarot

et al. 2022

Clinical Microbiology and Infection

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Objectives During the COVID-19 pandemic, numerous cases of chilblains have been reported. However, in most cases, RT-PCR or serology did not confirm SARS-CoV-2 infection. Hypotheses have been raised about an interferon-mediated immunological response to SARS-CoV-2, leading to effective clearance of the SARS-CoV-2 without the involvement of humoral immunity. Our objective was to explore the association between chilblains and exposure to SARS-CoV-2. Methods In this multicentre case-control study, cases were the 102 individuals referred to 5 referral hospitals for chilblains occurring during the first lockdown (March to May 2020). Controls were recruited from healthy volunteers’ files held by the same hospitals. All members of their households were included, resulting in 77 case households (262 individuals) and 74 control households (230 individuals). Household exposure to SARS-CoV-2 during the first lockdown was categorized as high, intermediate or low, using a pre-established algorithm based on individual data on symptoms, high-risk contacts, activities outside the home and RT-PCR testing. Participants were offered a SARS-CoV-2 serological test. Results After adjustment for age, the association between chilblains and viral exposure was estimated at OR=3.3, 95%CI (1.4-7.3) for an intermediate household exposure, and 6.9 (2.5-19.5) for a high household exposure to SARS-CoV-2. Out of 57 case households tested, 6 (11%) had positive serology for SARS-CoV-2, whereas all control households tested (n=50) were seronegative ( p =0.03). The effect of potential misclassification on exposure has been assessed in a bias analysis. Conclusions This case-control study demonstrates the association between chilblains occurring during the lockdown and household exposure to SARS-CoV-2. Trial Registration ClinicalTrials.gov Identifier NCT04455308.

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“…[25][26][27][28][29] Interestingly, information is accumulating about pernio-like lesions in "long-hauler" patients, with a signifi cant association reported between persistent cutaneous and extracutaneous symptoms. [30][31][32] While the debate continues, if these lesions are truly a COVID-19 manifestation, they are fortunately associated with high survival rates (96.4% 6 to 98.7% 3 ) and few or no systemic symptoms. 33,34…”

Section: ■ Pseudo-chilblains: Link To Covid-19 Debatedmentioning

confidence: 99%

Common skin signs of COVID-19 in adults: An update

Polly

Fernandez

2022

CCJM

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A s experience with caring for patients with COVID-19 has accumulated since the onset of the pandemic, so has our understanding of its associated cutaneous manifestations and their clinical implications.It is benefi cial to watch for cutaneous manifestations of COVID-19, both in and out of the hospital. For example, a study of more than 330,000 community-based patients in the United Kingdom 1 found that patientreported skin rash was associated with positive COVID-19 testing and was more predictive than fever. Additionally, an analysis of 296 hospitalized patients with COVID-19 in the United States 2 found that mucocutaneous fi ndings were associated with the need for mechanical ventilation, even when adjusted for age, body mass index, and comorbidities.COVID-19-associated cutaneous abnormalities are often grouped into 5 major categories (Table 1) 3 : • Morbilliform rash (containing macules and papules, resembling measles) • Urticaria (itchy red welts) • Vesicles (small blisters) • Pseudo-chilblains (also known as "COVID toes," painful infl ammation of the digits in response to cold) • Vaso-occlusive lesions (due to thrombosis and occlusion of small arteries, with subsequent ischemia). ■ MORBILLIFORM RASH: THE MOST COMMON SKIN MANIFESTATIONMorbilliform eruptions are common in many viral illnesses and were reported in patients with COVID-19 early in the pandemic. 4,5 International registry data indicate that mor-REVIEW

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Frequency of relapse and persistent cutaneous symptoms after a first episode of chilblain‐like lesion during the COVID‐19 pandemic

Cited by 13 publications

References 10 publications

Type I interferon response and vascular alteration in chilblain‐like lesions during the COVID‐19 outbreak*

Type I interferon response and vascular alteration in chilblain‐like lesions during the COVID‐19 outbreak*

Chilblains during lockdown are associated with household exposure to SARS-CoV-2: a multicentre case–control study

Common skin signs of COVID-19 in adults: An update

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