Chilblains in COVID-19 Infection

Abstract

COVID-19 has quickly become a worldwide pandemic and is well-known for its pulmonary complications. Dermatologic manifestations such as chilblain-like lesions have been recently described, but it is unclear if they are truly secondary to the infection or not. Here we describe a young patient who developed chilblain-like eruptions on his toes, likely secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We discuss the literature that supports the hypothesis that these are in fact secondary to the infection, as well as provide insight into the pathology of these lesions.

The JANUS of chronic inflammatory and autoimmune diseases onset during COVID-19 – A systematic review of the literature

“… [ 329 ] Urticarial vasculitis F 64 Antihistamines [ 330 ] Grover-like disease M 59 N.A. [ 331 ] Pernio-like eruption 4 M, 3 F 33 Topical/oral glucocorticoids or none [ 332 ] Chilblain-like lesions M 10 Topical glucocorticoids [ 333 ] Acral lesions 4 F, 1 M 3 None [ 334 ] Vascular lesions 3 F, 7 M 39.9 N.A. [ 335 ] Macular eruption with vasculitis F 81 None [ 336 ] Maculopapular rash 3 F, 1 M 21.75 Hydrocortisone, rupatadine and none [ 337 ] Ulcers 3 M 65.6 Antibiotics [ 338 ] Livedo racemosa and retiform purpura 4 55 Anticoagulation therapy [ ...…”

Clinical Characteristics and Transmission of COVID-19 in Children and Youths During 3 Waves of Outbreaks in Hong Kong

“…Chilblains, also known as COVID toes, presenting in both children and adults is a dermatological manifestation recognized as a symptom of COVID-19. 15 Although the exact pathophysiology of chilblains in individuals with COVID-19 remains to be elucidated, possible mechanisms include an abnormal inflammatory response attributed to type I interferonopathies or thrombotic microvasculature induced by complement activation and procoagulation state. 16 Another unique manifestation of COVID-19 was MIS-C, with features resembling those of Kawasaki disease, which developed 4 weeks after diagnosis of the infection in a patient who was not Chinese.…”

Cutaneous and histopathological features of coronavirus disease 2019 in pediatrics: A review article

“…In the reported cases, cutaneous lesions usually resolved without treatment after 7 to 10 days (between 5 days and 8 weeks) with no sequelae, except mild dyschromia in some cases. The most important differential diagnoses of chilblain‐like lesions were perniosis, lupus chilblain, and blue toe syndrome secondary to drugs, especially those that are used in the treatment of “attention‐deficit hyperactivity disorder”, such as methylphenidate hydrochloride 9,10,12,15,17,23,25,26,28,30‐35,41‐44 …”