A new dermoscopic pattern for chilblain-COVID-19–like skin lesions in adolescents

Fabbrocini, Gabriella; Vastarella, Maria; Nappa, Paola; Annunziata, Maria Carmela; Camela, Elisa; Greco, Vincenzo; Gaudiello, Francesca; Alessio, Maria; Pierri, Luca; Catzola, Andrea; Guarino, Alfredo

doi:10.1016/j.jdcr.2020.09.024

Cited by 8 publications

(30 citation statements)

References 8 publications

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“…All but 1 of the enrolled patients (94.1%) underwent dermoscopic evaluation at enrollment, whereas only 4 (23.5%) received a second assessment. In line with previous reports, 22 a dermoscopic triad 1F; eTable 1 in the Supplement). Red dots often appeared as dotted and comma-shaped congested vessels (9 of 16 patients [56.2%]), surrounding the rosettes in the early stage of the lesions.…”

Section: Dermoscopysupporting

confidence: 91%

Bilateral Chilblain-like Lesions of the Toes Characterized by Microvascular Remodeling in Adolescents During the COVID-19 Pandemic

et al. 2021

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IMPORTANCE Chilblain-like lesions have been one of the most frequently described cutaneous manifestations during the COVID-19 pandemic. Their etiopathogenesis, including the role of SARS-CoV-2, remains elusive. OBJECTIVE To examine the association of chilblain-like lesions with SARS-CoV-2 infection. DESIGN, SETTING, AND PARTICIPANTS This prospective case series enrolled 17 adolescents who presented with chilblain-like lesions from April 1 to June 30, 2020, at a tertiary referral academic hospital in Italy. MAIN OUTCOMES AND MEASURES Macroscopic (clinical and dermoscopic) and microscopic (histopathologic) analysis contributed to a thorough understanding of the lesions. Nasopharyngeal swab, serologic testing, and in situ hybridization of the skin biopsy specimens were performed to test for SARS-CoV-2 infection. Laboratory tests explored signs of systemic inflammation or thrombophilia. Structural changes in peripheral microcirculation were investigated by capillaroscopy. RESULTS Of the 17 adolescents (9 [52.9%] male; median [interquartile range] age, 13.2 [12.5-14.3] years) enrolled during the first wave of the COVID-19 pandemic, 16 (94.1%) had bilaterally localized distal erythematous or cyanotic lesions. A triad of red dots (16 [100%]), white rosettes (11 [68.8%]), and white streaks (10 [62.5%]) characterized the dermoscopic picture. Histologic analysis revealed a remodeling of the dermal blood vessels with a lobular arrangement, wall thickening, and a mild perivascular lymphocytic infiltrate. SARS-CoV-2 infection was excluded by molecular and serologic testing. In situ hybridization did not highlight the viral genome in the lesions. CONCLUSIONS AND RELEVANCEThis study delineated the clinical, histologic, and laboratory features of chilblain-like lesions that emerged during the COVID-19 pandemic, and its findings do not support their association with SARS-CoV-2 infection. The lesions occurred in otherwise healthy adolescents, had a long but benign course to self-resolution, and were characterized by a microvascular remodeling with perivascular lymphocytic infiltrate but no other signs of vasculitis.These results suggest that chilblain-like lesions do not imply a concomitant SARS-CoV-2 infection.Ongoing studies will help clarify the etiopathogenic mechanisms.

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Section: Dermoscopysupporting

confidence: 91%

Bilateral Chilblain-like Lesions of the Toes Characterized by Microvascular Remodeling in Adolescents During the COVID-19 Pandemic

et al. 2021

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“…In the meta‐analysis for prevalence of positive serology, 15 studies were excluded for not having performed serological testing in their participants 10,18–20,22,23,26–34 . The pooled prevalence of positive serologies for SARS‐CoV‐2 antibodies in all patients with CLL was 7.2% (95% CI, 4.7–10.2%; Fig.…”

Section: Resultsmentioning

confidence: 99%

Are the chilblain‐like lesions observed during the COVID‐19 pandemic due to severe acute respiratory syndrome coronavirus 2? Systematic review and meta‐analysis

Sánchez-García

Hernández-Quiles

de-Miguel-Balsa

et al. 2021

Acad Dermatol Venereol

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The expansion of the COVID‐19 pandemic has been accompanied by numerous reports of chilblain‐like lesions (CLL) in different countries; however, the pathogenesis of these lesions is still unclear. This systematic review and meta‐analysis aimed to assess the prevalence of COVID‐19 (diagnosed using PCR and/or serology) in patients with CLL. We undertook a literature search in PubMed, Embase, and Scopus (to 15 March 2021), including studies that reported on the number of patients with CLL with positive PCR and/or serology for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) or with a clinical suspicion of COVID‐19. Regardless of data heterogeneity, a random‐effects model was used to pool prevalence estimates. The meta‐analysis included 63 original studies, involving 2919 cases of CLL. A subgroup of these patients underwent diagnostic tests for COVID‐19 (PCR: n = 1154, 39.5%; serology: n = 943, 32.3%). The pooled prevalence of COVID‐19 in the overall sample and in the subgroup who were tested for COVID‐19 was, respectively: (i) positive PCR: 2.6% [95% confidence interval (CI) 1.9% to 3.4%] and 5.5% (95% CI, 3.7–7.7%); (ii) positive serology for SARS‐CoV‐2: 7.2% (95% CI, 4.7–10.2%) and 11.8% (95% CI, 7.9–16.3%); and (iii) positive PCR and/or serology, 15.2% (95% CI, 10.4–20.7%) and 7.5% (95% CI, 5.1–10.3%). Altogether, a small proportion of diagnostic tests for SARS‐CoV‐2, both PCR and serologies, show positive results in patients with CLL.

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“…[ 13 14 ] Fabbrocini et al . [ 34 ] described the dermoscopic features of active and subsiding chilblain-like lesions. Active lesions showed red dots, white rosettes, white streaks over a pinkish-reddish background, white or yellow scales, yellow crusts, and focally distributed orange-yellowish structureless areas.…”

Section: Cutaneous Manifestations Of Covid-19 Diseasementioning

confidence: 99%

Dermatological Manifestations Associated with COVID-19 Infection

Panda

Dash

Behera

et al. 2021

Indian Journal of Dermatology

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The severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) causing the 2019 coronavirus disease (COVID-19) has infected millions in recent years and is a major public health concern. Various cutaneous manifestations of the COVID-19 disease have been identified. Skin is a mirror to internal disease and can be the presenting sign of COVID-19 disease. Several cutaneous manifestations can indicate severe COVID-19 disease. In the present scenario, physicians should know the various cutaneous manifestations of COVID-19 disease for early diagnosis and proper management of the disease.

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A new dermoscopic pattern for chilblain-COVID-19–like skin lesions in adolescents

Cited by 8 publications

References 8 publications

Bilateral Chilblain-like Lesions of the Toes Characterized by Microvascular Remodeling in Adolescents During the COVID-19 Pandemic

Bilateral Chilblain-like Lesions of the Toes Characterized by Microvascular Remodeling in Adolescents During the COVID-19 Pandemic

Are the chilblain‐like lesions observed during the COVID‐19 pandemic due to severe acute respiratory syndrome coronavirus 2? Systematic review and meta‐analysis

Dermatological Manifestations Associated with COVID-19 Infection

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