Chilblains a Common Finding During COVID-19 Pandemic

By Megan Brooks

May 15, 2020

NEW YORK (Reuters Health) — Skin lesions, and chilblains in particular, are a common cutaneous finding during the COVID-19 pandemic, according to results of a retrospective nationwide study from France.

While most patients in the cohort were not tested for SARS-CoV2, "the number of observed chilblain-like lesions, in patients without significant past medical history, is extremely unusual during the spring season in France, especially as people are staying inside, and may suggest a link with COVID-19," the study team writes in the Journal of the American Academy of Dermatology.

"This manifestation may be induced by an inflammatory endothelitis of small cutaneous vessels and/or and interferon-like cytokine production," corresponding author Dr. Martine Bagot of Saint-Louis Hospital and the University of Paris told Reuters Health by email.

The research team took a look back at skin lesions encountered in the outpatient setting during the COVID-19 pandemic in France from mid-March to mid-April. The cohort included 277 patients (median age, 27 years). About half were men.

Skin lesions were classified as acral (80%), vesicular (15%), urticarial (9%), morbilliform (9%), petechial (3%), livedo reticularis (1%) and other (15%). Some patients had skin lesions fitting in multiple categories.

Acral lesions were "unexpectedly" common and chilblain-like lesions were the most common of the acral lesions (75%), the authors report. Vesicular acral (dyshidrosis-like) lesions were reported in 14% of cases and acrodynia was present in 6%, sometimes isolated.

Thirty-four of the 277 patients had a SARS-Cov2 PCR test and 25 were positive (74%). Seven of these 25 (28%) had acral lesions. Among the patients without a positive PCR test, 115 patients had suggestive extracutaneous symptoms and/or reported a close contact with a COVID-19 patient.

In addition, 59 patients had isolated chilblains (no prior history of chilblains and in the absence of cold exposure), without associated extracutaneous symptoms. This "may suggest cutaneous symptoms of COVID-19, since this finding has been found in some patients with a positive SARS-Cov2 PCR test in our case series and in two recently published case reports," the researchers say.

Histological examination of three chilblain-like lesions showed a lichenoid dermatitis with a perivascular and eccrine mononuclear infiltrate, and vascular microthrombi in two cases.

The presence of microthrombi in chilblain patients is "consistent with the altered coagulation status observed in severe COVID-19 patients," the researchers note.

"Although the number of tested patients does not allow us to draw firm conclusions regarding a direct link between SARS-CoV2 and these skin lesions, the unexpected outbreak of acral skin lesions in this epidemic context requires further investigation," they conclude.

The American Academy of Dermatology has set up an online registry to understand dermatologic manifestations of the COVID-19 virus. Dermatologists are asked to provide information on COVID-19 patients who develop dermatologic manifestations, or dermatology patients with an existing condition who then develop COVID-19 (https://bit.ly/362e1Fa).

SOURCE: https://bit.ly/2yHUAoZ Journal of the American Academy of Dermatology, online April 28, 2020.

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