Perniosis during the COVID‐19 pandemic: Negative anti‐SARS‐CoV‐2 immunohistochemistry in six patients and comparison to perniosis before the emergence of SARS‐CoV‐2

Abstract

Background: Acral inflammatory lesions that have some resemblance to idiopathic or autoimmune-associated perniosis (chilblains) have been described in multiple countries during the COVID-19 pandemic. Methods: We examined histopathologic findings in six consecutive such cases from five patients received in mid-May to mid-June of 2020, evaluating immunohistochemical staining for the SARS-CoV-2 nucleocapsid protein. We compared these six cases to eight cases diagnosed as perniosis between January and June of 2019. Results: Five of six lesions with perniosis-like histopathology during the COVID-19 pandemic had distinctive tight cuffing of lymphocytes; intravascular material was present in one case. SARS-CoV-2 immunohistochemical staining using an antibody directed at the nucleocapsid protein was negative in all six cases. Only one of eight specimens with microscopic findings of perniosis received prior to the COVID-19 pandemic had tightly cuffed perivascular lymphocytes, and none had obvious intravascular occlusion. Conclusions: A tightly cuffed pattern of perivascular lymphocytes is a feature of perniosis during the COVID-19 pandemic. The absence of SARS-CoV-2 nucleocapsid protein in these cases suggests against the virus being directly present in these lesions.

Skin Manifestations Associated with COVID-19: Current Knowledge and Future Perspectives

“…Livedo reticularis-like lesions are frequently mild, transient and not associated with thromboembolic complications [68, 69]. On the contrary, livedo racemosa-like lesions and retiform purpura have often been described in patients with severe coagulopathy [60-72].…”

COVID toes: where do we stand with the current evidence?

“…-Some authors have also shown positive anti-SARS-CoV/SARS-CoV-2 immunostaining on skin biopsy specimens of chilblains, which seem to confirm the presence of the virus in the lesions (Colmenero et al, 2020;Santonja et al, 2020). However, due to lack of specificity, these immunostainings should be interpreted with caution (Baeck et al, 2020b;Ko et al, 2020). -Conversely, RT-PCR and anti-SARS-CoV-2 serology were mostly negative (Baeck et al, 2020c;Caselli et al, 2020;Colonna et al, 2020;Denina et al, 2020;El Hachem et al, 2020;Freeman et al, 2020b;Garcia-Lara et al, 2020;García-Legaz Martínez et al, 2020;Le Cleach et al, 2020;Lesort et al, 2020;Mahieu et al, 2020;Neri et al, 2020;Rizzoli et al, 2020;Roca-Ginés et al, 2020;Rouanet et al, 2020;Stavert et al, 2020).…”

Idiopathic perniosis presenting as acral purpuric lesions: Clustering of cases before COVID ‐19 pandemic and their comparison with chilblain like lesions reported in the literature

“…Clustering of true IP in children consequent to lifestyle changes during the lockdown has also been reported 5 . Histopathological characteristics of CLL have been described in limited studies and appear indistinguishable from IP 3,6‐12 . We at our tertiary care center in Dehradun (Uttarakhand) saw clustering of cases of IP from November 2019 till February 2020.…”

“…Keratinocyte necrosis was seen in a higher number of patients with IP (50%) as compared of CLL (22.2%–42.8%). Basal vacuolar damage has been reported in variable proportions in CLL ranging from 14.3% to 100% 6‐11 . However, in a large histopathological series of 18 CLL cases, it was seen in 77.7% 3 .…”