Chilblains-like skin lesions reported in adolescents and young adults during the pandemic

As the coronavirus disease (COVID-19) pandemic grows, more manifestations of viral infection emerge.

Early in the pandemic, people with COVID-19 reported symptoms of fever, cough, and difficulty breathing. Later, other symptoms were added, such as loss of taste, loss of smell, and mouth injuries in children.

A team of investigators from the Department of Dermatology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain, and the Pediatric Dermatology Association, Bari, Italy, say acral, chilblap-like ischemic lesions have been reported worldwide during the COVID-19 pandemic. .

I study

The overall clinical presentation, course, and outcome of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children differs from adults. While urticaria, maculopapular rash, or vesicular rash can occur in people of all ages, chilblains, erythema multiforme (EM), and skin manifestations of Pediatric Multisystem Inflammatory Syndrome temporarily associated with SARS-CoV-2 (PIMS-TS) are most frequently seen in young patients.

To arrive at the results of the study, published in Journal of Clinical and Experimental Dermatology, the team summarized current knowledge on the cutaneous manifestations of COVID-19 in children after a comprehensive review of articles published in the literature on the personal experience of dermatologists in Europe.

Injuries similar to chilblains

Chilblains are a painful, itchy swelling on the skin, usually visible on the hands and feet, caused by poor skin circulation when exposed to cold.

COVID-19-related chill-like lesions are characterized by erythematous edematous or blistering skin lesions affecting the toes and soles of the feet. They appear less frequently on the fingers and hands.

Injuries are more common in children, adolescents, and young adults. Most patients have excellent health and mild symptoms. Recovery in all cases is four to eight weeks. The team said that although the link between COVID-19 and chilblains has yet to be proven, it seems likely.

Since March 2020, several acral lesions or chilblains-like reports of pinnus have been circulating on social media and Google Trends. Many people have searched for keywords such as “chilblains”, “toes”, “fingers” and “coronavirus” related injuries in France.

However, the first published study and the case of a possible chilblain-like lesion associated with SARS-CoV-2- occurred in Italy, followed by some similar case reports in Spain and the Middle East.

Patients who reported COVID-19-related injuries were mostly young, confined to their homes due to blockade and unprecedented orders of the condition.

In Spain, doctors report cases of “pseudo-chilblains” in 19% of 375 patients with skin manifestations of COVID-19. Of these, only one had a previous history of pernio.

Additionally, the 277 cases reported in France with chilblains-like lesions were mostly confirmed or suspected cases of COVID-19.

Commonly seen in children and adolescents

Injuries are commonly seen in children and adolescents who are in good health. However, they are rarely seen in children under the age of 10.

In 74-100 percent of cases, lesions appeared on the feet. Multiple, round lesions typically affect the entire toe with a clear demarcation. In some cases, the lesions may turn dark purple with black scabs.

Children and adolescents who develop the lesions are usually asymptomatic, but local pain and itching may occur.

Additionally, all children and adolescents had a positive health outcome and had no complications. The reported recovery ranged from 12 days to more than eight weeks.

COVID-19 and chilblains injuries

The researchers explained some of the pathogenic mechanisms on how chilblains are related to COVID-19.

First, patients with severe COVID-19 have a reduced response to type I interferon (IFN) and an increase in tumor necrosis factor and interleukin production. The team explained that patients with chilblains exhibit a strong IFN-I response, thereby reducing viral replication.

However, the early IFN-I response could trigger microangiopathic changes, generating lesions similar to those of chilblains.

Another theory involves the coagulopathy hypothesis. Patients with COVID-19 are at higher risk for thromboembolism, which can induce the development of acral ischemia.

Additionally, patients with neurological signs were found to have perfusion abnormalities. Microvascular abnormalities have been reported in lung biopsies, suggesting a direct viral effect on the vessels. Furthermore, viral proteins were also observed in the endothelial cells of the skin of two patients with chilblains.

Finally, the researchers noted that a change in habits during the pandemic and blockade could be linked to chilblains. This can be due to walking barefoot at home, lack of physical activity and stress.