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The authors review 22 children (<18 years old) with chilblain-like lesions on toes, feet, and/or fingers who presented to the emergency department during the peak of COVID-19 in Madrid, Spain. In 55%, chilblains were the only manifestation—some with mild pruritus/pain—whereas 45% had mild respiratory and/or gastrointestinal symptoms that presented at a mean of 16 days prior to skin findings. None had fever. In all patients, coagulation tests, hemogram, serum chemistry, and lupus anticoagulant were normal. SARS-CoV-2 PCR was positive in 1 of 19 tested. Skin biopsies from 6 patients showed chilblains. All patients had an excellent outcome, and lesions started to improve after 1 week, with complete resolution in 3 to 5 weeks.
Although chilblains are uncommon in children, especially without cold exposures, this review suggests that acute chilblains may be a cutaneous sign of COVID-19 that is associated with an excellent prognosis in children and adolescents. All cases resolved spontaneously without complications. The low rate of PCR positivity may be related to lower sensitivity in mild cases.
– InYoung Kim, MD, PhD
This abstract is available on the publisher's site.
Different skin manifestations of COVID-19 are being reported. Acral lesions on the hands and feet, closely resembling chilblains, have been recognized during the peak incidence of the COVID-19 pandemic.
MATERIAL AND METHODS
A retrospective review of 22 children and adolescents with chilblain-like lesions seen over a short period of time in the Emergency Department of a children's hospital during the peak incidence of COVID-19 in Madrid, Spain.
All patients had lesions clinically consistent with chilblains of the toes or feet, with three also having lesions of the fingers. Pruritus and mild pain were the only skin symptoms elicited, and only 10 had mild respiratory and/or GI symptoms. None had fever. Coagulation tests, hemogram, serum chemistry, and lupus anticoagulant were normal in all patients tested. One out of 16 tested cases had elevated D-dimer results, but without systemic symptoms or other laboratory anomalies. SARS-CoV-2 PCR tested in 19 cases was positive in just one case. Skin biopsies obtained in six patients were consistent with chilblains. On follow-up, all cases showed spontaneous marked improvement or complete healing.
Acute chilblains were observed during COVID-19 pandemic in children and teenagers. It is a mildly symptomatic condition with an excellent prognosis, usually requiring no therapy. Etiopathogenesis remains unknown.
Chilblains in Children in the Setting of COVID-19 Pandemic
Pediatr Dermatol 2020 May 09;[EPub Ahead of Print], D Andina, L Noguera-Morel, M Bascuas-Arribas, J Gaitero-Tristán, JA Alonso-Cadenas, S Escalada-Pellitero, Á Hernández-Martín, M de la Torre-Espi, I Colmenero, A Torrelo