Management of pernio‐like cutaneous manifestations in children during the outbreak of COVID‐19

Abstract

Background During the outbreak of COVID‐19 many pernio‐like lesions have been increasingly reported. The aim of the study is to describe our management of these skin manifestations and to evaluate a possible correlation to SARS‐CoV‐2 infection. Methods All patients underwent clinical and laboratory tests to detect a possible underlying connective disease and also to specific SARS‐CoV‐2 investigations such as oropharyngeal swab and IgG‐IgM serology. Results Nine patients aged between five and fifteen years old were evaluated. Skin lesions observed were purplish, erythematous and oedematous, in some cases painful and itchy. Six out of nine had respiratory and systemic symptoms (cough, nasal congestion, chills, fever, asthenia) that preceded cutaneous findings of approximately two weeks. Concerning blood exams, three out of nine had D‐dimer weakly increased, four had ANA positivity: two with a title 1:160, one with 1:320 and one with 1:5120 and a speckled pattern. The latter patient had also ENA SS‐A positive and RF positivity, confirmed at a second check, so as to allow us to make a diagnosis of connective tissue disease. Four out of nine had aPL positivity (IgM). Reactants acute phase were all negative. Oropharyngeal swabs and serology tests for SARS‐CoV‐2 was negative (borderline in one patient for IgM). No treatment was needed. Conclusions Even if we do not have enough data to prove it, we hypothesize a correlation between pernio‐like lesions and SARS‐CoV‐2 infection for an increased number of these lesions described during the pandemic and also because such manifestations appeared when temperatures were mild and patients were at home in isolation for the lockdown. Many questions remain open about interaction host‐virus. This article is protected by copyright. All rights reserved.

The JANUS of chronic inflammatory and autoimmune diseases onset during COVID-19 – A systematic review of the literature

“… [ 367 ] Chilblain-like lesions 4 M, 5 F 11 N.A. [ 368 ] Abbreviations: N.A. : information not available.…”

COVID-19–related skin manifestations: Update on therapy

“…Management of common chronic inflammatory skin diseases, as well as skin cancers or consequences of personal protective devices use were also discarded. Very few reports explicitly included as keywords or title the therapeutic approach for the occurrence of skin lesions associated with COVID-19 infection, 35 , 36 and several expert reviews were also considered to collect information on recommended treatment. 13 , 14 , 15 , 16…”

“…The majority of reports concerned chilblain/pernio-like cutaneous manifestations and specify that no treatment was needed. 28 , 36 , 39 , 40 , 41 , 42 For isolated cases, 37 , 38 two expert opinion leaders suggested that high-potency topical corticosteroids may be helpful if the lesions were causing discomfort. 16 , 43 …”

COVID toes: a unique cutaneous indicator of COVID-19

“…The Southwest Respiratory and Critical Care Chronicles 2021;9(39): [15][16][17][18][19][20][21] retrospective review of 26 children with COVID toes in Italy in March-April 2020 also demonstrated that all patients recovered without any treatment. 22 In these studies and other published case reports, a variety of treatments have been used. Patients have received symptomatic treatment (oral analgesia and antihistamines), topical heparin, topical nitroglycerin, and topical and systemic corticosteroids.…”

“…Patients have received symptomatic treatment (oral analgesia and antihistamines), topical heparin, topical nitroglycerin, and topical and systemic corticosteroids. [21][22][23][24] To date, no randomized control trials have been performed to assess the efficacy of treatment for COVID toes.…”