“COVID toes”: A meta‐analysis of case and observational studies on clinical, histopathological, and laboratory findings

Abstract

Background Coronavirus disease (COVID‐19) is related to several extrapulmonary disorders; however, little is known about the clinical, laboratory, and histopathological characteristics of pernio‐like skin lesions associated with COVID‐19 infection. Objective To evaluate and summarize the clinical, laboratory, and histopathological characteristics of pernio‐like lesions reported in the literature. Methods We conducted a search of the PubMed, SciELO, and ScienceDirect databases for articles published between January 1, 2020 and November 30, 2020, following the PRISMA recommendations (PROSPERO registration ID: CRD42020225055). The target population was individuals with suspected or laboratory‐confirmed COVID‐19 with pernio‐like lesions. Observational studies, research letters, and case/series reports were all eligible for inclusion. Observational studies were evaluated using a random‐effects model to calculate the weighted mean prevalence, overall mean, and 95% confidence interval. We evaluated case studies using the chi‐square test for dichotomous variables and the Mann‐Whitney test for continuous variables. Results A total of 187 patients from case reports and 715 patients from 18 observational studies were included. The mean age of patients was 16.6 years (range 14.5‐18.8). Feet were affected in 91.4% (87.0‐94.4%) of patients in observational studies. The proportion of patients with a positive RT‐PCR test was less than 15%. Lesion topography and morphology were associated with age. Conclusion Lesions mostly occurred in pediatric patients, and the morphological characteristics tended to differ between pediatric and non‐pediatric populations. There is a possible multifactorial component in lesion pathophysiology. The non‐positivity of laboratory tests does not exclude an association with COVID‐19. Pernio‐like lesions may be a late manifestation of COVID‐19.

COVID-19 pandemic-associated chilblains: more links for SARS-CoV-2 and less evidence for high interferon type I systemic response

“…The role of SARS‐CoV‐2 infection as a trigger of CAC has been widely debated due to the low levels of positive real‐time PCR nasopharyngeal and IgG serologies, which are within the ranges, respectively, of 5·5–13·3% and 7·2–11·8%. 1 , 4 In our series, by using a microneutralization assay for isolated IgA antibodies and serum SARS‐CoV‐2 nucleocapsid antigen detection, we found an overall virological confirmation of SARS‐CoV‐2 infection in 22% of patients, including 32% in children. This latter result is consistent with the frequency of 30–37% of seroconversion observed in previous series of children with asymptomatic and/or mild SARS‐CoV‐2 infection during the acute and convalescent periods, 5 , 6 adding new arguments for a causative role of SARS‐CoV‐2 in CAC.…”

“…Data were collected in one-toone, semistructured, telephone interviews and analysed using framework analysis. 4 Twenty-four participants were recruited from two sites in the TUDOR RCT (Table 1). Three main themes represent the data.…”

Prevalence and patterns of cutaneous manifestations in 1245 COVID‐19 patients in Japan: a single‐centre study

“…The median age of pseudo‐chilblains is reported to be 16.6–27.2 years and approximately 80% of cases were noticed at more than 2 weeks after onset whereas the figures for our study are median age of pseudo‐chilblains of 68 years and mean duration of hospitalization of 14.0 days. 4 , 6 , 7 …”

Complications of severe acute respiratory syndrome coronavirus 2 infection in children

“…Relief of local pain or pruritus may require the administration of oral analgesic or antihistamines. Use of topical or oral corticosteroids is controversial [42].…”