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Chilblain-Like Lesions on Feet and Hands During the COVID-19 Pandemic
TAKE-HOME MESSAGE
- In this case series from Spain, authors present data from 6 patients with chilblain-like lesions. Lesions were initially red papules and developed into purpuric macules over approximately 1 week. Lesions were most commonly seen on the toes, soles, fingers, extremities, and/or heel. Symptoms of coronavirus were generally absent or mild, except in one 91-year-old patient who required hospitalization. While 2 patients tested positive for COVID-19 prior to onset of these symptoms, one 15-year-old patient tested negative despite bilateral pneumonia, and 3 could not be tested, although 2 of these had known high risk of exposure.
- Despite the inability to definitively correlate without confirmatory testing in all patients, the high rate of consultations for chilblains-like lesions weeks after reaching the national peak of COVID-19 infections in Spain highlights this as a suspicious phenomenon for a late-stage manifestation of COVID-19, particularly considering similar observations in other countries.
– Caroline K. Crabtree, MD
abstract
This abstract is available on the publisher's site.
Access this abstract nowThe COVID‐19 pandemic is caused by a novel coronavirus, SARS‐CoV‐2, isolated in patients with severe pneumonia in China on December 30, 2019, having spread throughout the world since then with 2,056,054 cases diagnosed and 134,177 deaths (as of 15th April 2020).
The clinical presentation widely referenced is fever, cough, headache, myalgia, asthenia, anosmia, and diarrhea; but few dermatological findings associated with the virus have been described to date.
Over recent days, a series of cases in Spain have begun to emerge noted by many dermatologists. Amongst them is a group to which the authors belong called Teledermasolidaria. This group of dermatologists has been treating urgent cases from home via an application made available by the Spanish Academy of Dermatology and Venereology (AEDV).
Additional Info
Chilblain-Like Lesions on Feet and Hands During the COVID-19 Pandemic
Int. J. Dermatol 2020 Apr 24;[EPub Ahead of Print], N Landa, M Mendieta-Eckert, P Fonda-Pascual, T AguirreFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Several skin manifestations have recently been linked to COVID-19 infection. Most intriguing are the pernio/chilblains-like lesions, occurring most often in adolescents and young adults who otherwise are asymptomatic. Several hundred sets of “COVID toes” have been seen in the US during the past few weeks through teledermatology, although the relationship with COVID-19 remains unclear. Virtually all show the classic red to purplish coloration on the dorsal aspect of the toes, sometimes with small nodules. Less common features are circular or ring-like lesions on the plantar or lateral aspects of the feet or toes, and involvement of the fingers (in contrast to the frequent involvement of fingers in traditional pernio/chilblains). Involvement may extend to other toes and superficial blisters and erosions may develop. Lesions may be asymptomatic, but many are pruritic or painful, particularly when touched. Toes may be swollen and too painful to wear shoes. Lesions typically last 10 to 14 days, but several have reported to be persistent for a few months already.
Biopsies to date are consistent with pernio, but occurrence in warmer weather and in unprecedented numbers during a pandemic strongly suggests the COVID-19 association. To date, however, few co-resident family members have developed COVID-19 infection. Although the minority had PCR testing for virus, results are largely negative. Antibody testing is in its early stages and risks being unreliable, but correlation has not yet been shown. Could the viral load be so low that it defies detection and leads to minimal transmission, but activates the immune system (presumably the interferon pathway) that targets the microvasculature? Is there a need for quarantine if pernio-like lesions occur, and, if so, when in the course? If antibodies cannot be detected, does that dispel the possible association, and, if so, what is causing the “COVID toes” epidemic? Hopefully, tracking evidence of COVID infection of affected individuals through registries will start to yield answers during the next few months.