Acral cutaneous lesions in the time of COVID‐19

Abstract

Dear Editor, Coronavirus disease 2019 (COVID-19) has become a pandemic condition, yet little is known about its dermatologic manifestations. 1,2 We report here on peculiar (perniosis-like) skin lesions, unreported in the previous years, observed in young outpatients visited in our dermatologic unit in the last 4 weeks of COVID-19 pandemic (March-April 2020). Similar cases were referred to us in the same period by paediatricians and dermatologists from Italy and European countries. We directly observed 14 cases including 11 children (average age 14.4 years, range 13-18) and three young adults (average age 29 years, range 23-39). In this series, three couples were siblings and the ratio female-male was 8 : 6. The cutaneous manifestations consisted of an acral eruption of erythemato-violaceous papules and macules, with possible bullous evolution, or digital swelling (Fig. 1a-c). Lesions were localized on the feet in eight cases, on the hands in four cases and on both sites in 2. Two

COVID Abdomen: SARS-CoV-2 Infection presenting as 'Acute Abdomen' in a Child

“…However, the preserved bowel sounds and the diarrheal onset of illness allowed us to wait with medical management. Varying skin lesions [7] had been described with COVID-19 infection, history of maculopapular rashes on the dorsum of feet had added the suspicion of COVID-19 in the index case.…”

Cutaneous Manifestations of COVID-19: A Systematic Review

“…13 Of note, these PC lesions were largely unrelated to cold exposure (secondary to social isolation and stay-at-home orders) or a prior history of Raynaud's disease. 9,20,32,33,34,36 As such, these cutaneous ndings may be categorized as COVID-19-induced pseudo-chilblains rather than primary pernio disease. The majority of PC cases were associated with milder disease, resolving disease, or negative laboratory testing.…”

“…One study reported persistent PC that required 2 to 4 weeks for complete resolution. 9 Of the dermatologic ndings that were symptomatic, the majority were pruritic (n = 295), followed by painful (n = 68) or burning (n = 24). Most patients had no new drug intake in the 2 weeks preceding rash onset.…”

“…for COVID-19). 9,18,20,[33][34][35][36] These non-laboratory con rmed patients all presented during the COVID-19 outbreak and, for those with a negative COVID-19 PCR result, antibody testing was not available to establish the possibility of prior infection. Case fatality rates ranged from 0.0% to 13.6%.…”

Outpatient Management of Oligosymptomatic Patients with Respiratory Infection in the Era of SARS-CoV-2. Experience from Rural German General Practitioners 

“…The most common symptoms, depending on the time windows during the course of infection, are symptoms associated with respiratory diseases, such as fever, cough, sore throat, headache, chills, fatigue and myalgia, smell and taste dysfunction and gastrointestinal problems (10,11), but recently more severe cases have been associated with neurological symptoms, such as acute cerebral vascular disease, skeletal muscle injury and impaired consciousness (12). Perniosis-like skin symptoms may als be present (13,14). Risk factors for more severe cases of COVID-19 are hypertension, coronary artery disease, immunosuppression, and chronic lung disease (15).…”