Relapse of chilblain‐like lesions during the second wave of the COVID‐19 pandemic: a cohort follow‐up

Abstract

Funding sources: W.Y. was supported by the Yen Tjing Ling Medical Foundation.Conflicts of interest: A.P. receives departmental research funding as coinvestigator on a phase II Pfizer-funded clinical trial investigating the use of three kinase inhibitors in the treatment of hidradenitis suppurativa.

Evolution of incidence of chilblain‐like lesions in children during the first year of COVID‐19 pandemic

“…As reflected in Figure 1 While investigations to understand the pathophysiology of pandemic-associated pernio continue, [16][17][18][19] furthermore, the temperatures during the third wave were 1-1.5°C lower than mean temperatures from the three previous years.…”

“…While investigations to understand the pathophysiology of pandemic‐associated pernio continue, 16 , 17 , 18 , 19 evidence has shown that SARS‐CoV‐2 spike protein and robust IFN‐1 response are seen in the skin of patients with chilblains, suggesting an excessive innate immune skin response to SARS‐CoV‐2. These findings suggest IFN‐1 signaling may affect host outcomes to COVID‐19.…”

“…Recalcati et al described relapsing chilblains in seven young patients with lack of any evidence of SARS‐CoV‐2 infection but emphasized that most of these patients were children of health workers 15 . Hubiche et al observed a relatively high frequency of relapses in their chilblain‐like cohort; one‐third of the patients who had relapses were exposed to possible or proved cases of COVID‐19 within the household, suggesting that re‐exposure to SARS‐CoV‐2 infection might trigger a relapse in chilblain‐like lesions 16 . In our series, we have documented 5 cases of recurrences in three different scenarios: close contact with confirmed cases and negative test (2 cases), no close contact with confirmed cases and negative test (2 cases), and one case with no documented contact with cases of COVID‐19 who tested positive for SARS‐CoV‐2 on a RAT which indicated an active SARS‐CoV‐2 infection.…”

Common skin signs of COVID-19 in adults: An update

“…However, proponents of the association with COVID-19 point to "outbreaks" of chilblain-like lesions corresponding to CO-VID-19 waves and propose that an effi cient, type I interferon-driven antiviral response could induce pernio-like lesions and suppress both symptoms and confi rmatory testing. [25][26][27][28][29] Interestingly, information is accumulating about pernio-like lesions in "long-hauler" patients, with a signifi cant association reported between persistent cutaneous and extracutaneous symptoms. [30][31][32] While the debate continues, if these lesions are truly a COVID-19 manifestation, they are fortunately associated with high survival rates (96.4% 6 to 98.7% 3 ) and few or no systemic symptoms.…”

Quoi de neuf en dermatologie clinique ?

“…Une étude plus récente sur 50 malades a détecté par Enzyme-Linked Immunospot (ELISPOT) une réponse IFN gamma sur cellules mononucléées sanguines stimulées in vitro par des protéines virales chez 33 % des patients avec engelures possiblement associées au SARS-CoV-2 mais dans la même proportion chez des contrôles sains, rendant moins probable le schéma COVID et réponse IFN/engelure [ 13 ]. Lors de la 2e vague, en automne, les taux de récidive des engelures étaient supérieurs à 60 % [ [14] , [15] ]. Une équipe a étudié le taux de récidive des engelures et la corrélation géographique avec les cas de COVID dans 23 centres en Californie.…”