Outbreak of chilblain-like acral lesions in children in the metropolitan area of Milan, Italy, during the COVID-19 pandemic

Colonna, Cristiana; Genovese, Giovanni; Monzani, Nicola Adriano; Picca, Marina; Boggio, Francesca; Gianotti, Raffaele; Marzano, Angelo Valerio

doi:10.1016/j.jaad.2020.06.019

Cited by 44 publications

(82 citation statements)

References 6 publications

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“…The authors have proposed virus-induced endothelial damage may be the mechanism in the pathogenesis of COVID-19 chilblains and possibly also in a group of severely affected patients with features of widespread microangiopathy. This observation has also been supported by another study [87].…”

Section: Specific Molecular Confirmation Of Covid-19supporting

confidence: 84%

“…Viral detection by immunohistochemical and in situ hybridization asssays SARS-CoV-2 viral protein can be detected in the tissue specimens using virus-specific antibodies and targeting viral RNA by in situ hybridization techniques [56,59,[85][86][87]. Researchers have demonstrated in situ expression of SARS-CoV-2 in the airways and lung in the deceased COVID-19 individuals.…”

Section: Specific Molecular Confirmation Of Covid-19mentioning

confidence: 99%

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Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and coronavirus disease 19 (COVID-19) – anatomic pathology perspective on current knowledge

Mohanty¹,

Satapathy²,

Naidu³

et al. 2020

Diagn Pathol

148

144

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Background: The world is currently witnessing a major devastating pandemic of Coronavirus disease-2019 (COVID-19). This disease is caused by a novel coronavirus named Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). It primarily affects the respiratory tract and particularly the lungs. The virus enters the cell by attaching its spike-like surface projections to the angiotensin-converting enzyme-2 (ACE-2) expressed in various tissues. Though the majority of symptomatic patients have mild flu-like symptoms, a significant minority develop severe lung injury with acute respiratory distress syndrome (ARDS), leading to considerable morbidity and mortality. Elderly patients with previous cardiovascular comorbidities are particularly susceptible to severe clinical manifestations. Body: Currently, our limited knowledge of the pathologic findings is based on post-mortem biopsies, a few limited autopsies, and very few complete autopsies. From these reports, we know that the virus can be found in various organs but the most striking tissue damage involves the lungs resulting almost always in diffuse alveolar damage with interstitial edema, capillary congestion, and occasional interstitial lymphocytosis, causing hypoxia, multiorgan failure, and death. A few pathology studies have also reported intravascular microthrombi and pulmonary thrombembolism. Although the clinical presentation of this disease is fairly well characterized, knowledge of the pathologic aspects remains comparatively limited. Conclusion: In this review, we discuss clinical, pathologic, and genomic features of COVID-19, review current hypotheses regarding the pathogenesis, and briefly discuss the clinical characteristics. We also compare the salient features of COVID-19 with other coronavirus-related illnesses that have posed significant public health issues in the past, including SARS and the Middle East Respiratory Syndrome (MERS).

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Section: Specific Molecular Confirmation Of Covid-19supporting

confidence: 84%

Section: Specific Molecular Confirmation Of Covid-19mentioning

confidence: 99%

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and coronavirus disease 19 (COVID-19) – anatomic pathology perspective on current knowledge

Mohanty¹,

Satapathy²,

Naidu³

et al. 2020

Diagn Pathol

148

144

View full text Add to dashboard Cite

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“…11,15,[34][35][36] These vascular lesions were commonly identified among adolescents and young adults. 11,15,34,35,[37][38][39][40][41][42][43] Anatomical locations of chilblain-like lesions were consistent between studies with feet and hands being affected the most often. On the hands and feet, the acral lesions would typically localize on the fingers and toes, respectively.…”

Section: Chilblain-like Lesions (Covid Toes)supporting

confidence: 63%

“…34 Dermatological symptoms commonly associated with chilblain-like lesions were pain and pruritus. 11,34,35,37,38 Many of the patients presenting with pernio-like lesions were young and healthy. These rashes were typically associated with relatively mild COVID-19 infections.…”

Section: Chilblain-like Lesions (Covid Toes)mentioning

confidence: 99%

Cutaneous Manifestations of COVID-19: A Systematic Review

Singh

Kaur

Singh

et al. 2021

Advances in Wound Care

124

189

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Objective: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is currently a pandemic. Although pulmonary health has been the primary focus of studies during the early days of COVID-19, development of a comprehensive understanding of this emergent disease requires knowledge of all possible disease manifestations in affected patients. This Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant review focuses on cutaneous manifestations reported in COVID-19 patients. Approach: Literature review was conducted using the PubMed database to examine various cutaneous manifestations related to the SARS-CoV-2 infection. Published articles (n = 56) related to search criteria from the onset of the COVID-19 pandemic to June 30, 2020, were included. The primary literature articles included in this study were mainly from France, Spain, Italy, and the United Kingdom. Results: Unique to many other symptoms of COVID-19, its cutaneous manifestations have been found in people of all age groups, including children. The cutaneous manifestations of COVID-19 are varied and include maculopapular, chilblain-like, urticarial, vesicular, livedoid, and petechial lesions. In addition, rashes are common in multisystem inflammatory syndrome in children, a new and serious health condition that shares symptoms with Kawasaki disease and is likely related to COVID-19. In addition, personal protective equipmentrelated skin wounds are of serious concern since broken cutaneous barriers can create an opening for potential COVID-19 infections. Innovation and Conclusion: As this virus continues to spread silently, mainly through asymptomatic carriers, an accurate and rapid identification of these cutaneous manifestations may be vital to early diagnosis and lead to possible better prognosis in COVID-19 patients. This systematic review and photo atlas provide a detailed analysis of the skin pathologies related to COVID-19. Study of these cutaneous manifestations and their pathogenesis, as well their significance in human health will help define COVID-19 in its entirety, which is a prerequisite to its effective management.

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“…It was reported as 'suspected', as the subjects were not able to be fully assessed or indeed even confirmed as having had the infection. With increasing interest in these lesions, national newspapers in many countries were reporting these as potential signs of the disease of children and further medical publications rapidly followed [8][9][10][11][12][13][14] on a daily basis. All of these were case reports and case series.…”

Section: Main Textmentioning

confidence: 99%

The mystery of the COVID toes – turning evidence‐based medicine on its head

Bristow

Borthwick

2020

Journal of Foot and Ankle Research

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The recent and rapid emergence of COVID-19 infection has led to a flood of publications describing all aspects of the disease and its presentation. The appearance of chilblain-like lesions, in children and young adults has particularly caught the attention of healthcare professionals with an interest in the foot. With such a novel infection, demand for information is high at a time when evidence is scarce. Consequently, there has been a renaissance in the publication of case studies. This type of research, previously relegated from many mainstream journals, as a low level source of evidence, has permitted the rapid reporting, publication and dissemination of much needed clinical data which can be used as a foundation to inform further research and investigations about a new global infection.

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Outbreak of chilblain-like acral lesions in children in the metropolitan area of Milan, Italy, during the COVID-19 pandemic

Cited by 44 publications

References 6 publications

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and coronavirus disease 19 (COVID-19) – anatomic pathology perspective on current knowledge

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and coronavirus disease 19 (COVID-19) – anatomic pathology perspective on current knowledge

Cutaneous Manifestations of COVID-19: A Systematic Review

The mystery of the COVID toes – turning evidence‐based medicine on its head

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