Assessment of Acute Acral Lesions in a Case Series of Children and Adolescents During the COVID-19 Pandemic

Abstract

t the end of 2019, a novel coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified as the cause of an outbreak of pneumonia and severe acute respiratory syndrome in Wuhan, China. 1 On January 30, 2020, the World Health Organization declared coronavirus disease 2019 (COVID-19) a public health emergency of international concern. 2 Although SARS-CoV-2 infection can affect individuals of any age, severe illness is uncommon in children. Recently, possible COVID-19-related skin changes have been described: mostly urticaria, drug-related eruptions, and chickenpox-like vesicles. 3 In addition, cutaneous lesions referred to as acute acro-ischemia have been reported as a possible sign of SARS-CoV-2 infection in adolescents and children. 4 In this article, we report an outbreak of acral skin lesions observed between April 9 and April 15, 2020.

Acral lesions in a pediatric population during the COVID-19 pandemic: a case series of 36 patients from a single hospital in Spain

“…Red cell extravasation and dermal edema are also often described [19]. The published data about complementary blood tests reveal the lack of relevant findings [7,9,12,20]. Unfortunately, we were not able to perform either a skin biopsy or blood tests for any of our patients owing to the lack of resources and the remote evaluation.…”

Cutaneous manifestations of COVID-19 in children (and adults): A virus that does not discriminate

“… 27 Some authors have speculated that the pseudo-chilblains may be attributable to novel lifestyle changes due to COVID-19, such as decreased activity or walking barefoot in an unheated environment. 28 , 29 Despite these ideas, the constellation of papers reporting cutaneous manifestations of COVID-19 has led to calls of a skin eruption to be included in the list of clinical features suspicious of COVID-19 infection. 27 …”

Respuesta al comentario sobre «Perniosis del confinamiento, una vieja conocida en el contexto del COVID-19»

“…En ella aportan diversos argumentos que sin duda merecen ser considerados a la hora de valorar los casos de perniosis acontecidos durante la pandemia debida al SARS-CoV-2. De hecho, hemos realizado un estudio con 20 pacientes con las referidas lesiones, y compartimos muchos de estos puntos y referencias 2 .…”

“…La negatividad de la PCR no es un factor determinante a la hora de excluir causalidad. Tanto en nuestra serie, como en otras similares, ni los pacientes ni sus convivientes la tuvieron positiva, ni manifestaron otra clínica viral presente o pretérita 2 , 3 . Si bien existen casos familiares, la mentada negatividad clínica para otras manifestaciones del SARS-CoV-2 resulta intrigante.…”

“…En nuestra opinión, todos estos datos demuestran, hasta la fecha, una concurrencia temporal entre la COVID-19 y la perniosis. Pero actualmente no se ha demostrado causalidad de forma fehaciente 2 , 3 , 5 , 7 . No osamos aportar, ni mucho menos, la solución patogénica de esta entidad, únicamente añadimos ideas acerca de ella.…”