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Romita P, Maronese CA, DE Marco A, Balestri R, Belloni Fortina A, Brazzelli V, Colonna C, DI Lernia V, El Hachem M, Fabbrocini G, Foti C, Frasin LA, Guarneri C, Guerriero C, Guida S, Locatelli A, Neri I, Occella C, Offidani A, Oranges T, Pellacani G, Stinco G, Stingeni L, Barbagallo T, Campanati A, Cannavò SP, Caroppo F, Cavalli R, Costantini A, Cucchia R, Diociaiuti A, Filippeschi C, Francomano M, Giancristoforo S, Giuffrida R, Martina E, Monzani NA, Nappa P, Pastorino C, Patrizi A, Peccerillo F, Peris K, Recalcati S, Rizzoli L, Simonetti O, Vastarella M, Virdi A, Marzano AV, Bonamonte D. COVID 19-associated chilblain-like acral lesions among children and adolescents: an Italian retrospective, multicenter study. Ital J Dermatol Venerol 2023; 158:117-123. [PMID: 37153946 DOI: 10.23736/s2784-8671.23.07539-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND Since the COVID-19 pandemic started, great interest has been given to this disease, especially to its possible clinical presentations. Besides classical respiratory symptoms, dermatological manifestations occur quite often among infected and non-infected patients, particularly in children. A prominent IFN-I response, that is generally higher in children compared to adults, may not only cause chilblain lesions, but it could also prevent infection and viral replication, thus justifying the negative swab results, as well as the absence of relevant systemic symptoms in positive cases. Indeed, reports have emerged describing chilblain-like acral lesions in children and adolescents with either proven or suspected infection. METHODS Patients aged from 1 to 18 years old were enrolled in this study from 23 Italian dermatological units and were observed for an overall period of 6 months. Clinical pictures were collected along with data on the location and duration of skin lesions, their association with concomitant local and systemic symptoms, presence of nail and/or mucosal involvement, as well as histological, laboratory and imaging findings. RESULTS One hundred thirty-seven patients were included, of whom 56.9% were females. Mean age was 11.97±3.66 years. The most commonly affected sites were the feet (77 patients, 56.2%). Lesions (48.5%) featured cyanosis, chilblains, blisters, ecchymosis, bullae, erythema, edema, and papules. Concomitant skin manifestations included maculo-papular rashes (30%), unspecified rashes (25%), vesicular rashes (20%), erythema multiforme (10%), urticaria (10%) and erythema with desquamation (5%). Forty-one patients (29.9%) reported pruritus as the main symptom associated with chilblains, and 56 out of 137 patients also reported systemic symptoms such as respiratory symptoms (33.9%), fever (28%), intestinal (27%), headache (5.5%), asthenia (3.5%), and joint pain (2%). Associated comorbid conditions were observed in 9 patients presenting with skin lesions. Nasopharyngeal swabs turned out positive in 11 patients (8%), whereas the remainder were either negative (101, 73%) or unspecified (25, 18%). CONCLUSIONS COVID-19 has been credited as the etiology of the recent increase in acro-ischemic lesions. The present study provides a description of pediatric cutaneous manifestations deemed to be potentially associated with COVID-19, revealing a possible association between acral cyanosis and nasopharyngeal swab positivity in children and teenagers. The identification and characterization of newly recognized patterns of skin involvement may aid physicians in diagnosing cases of asymptomatic or pauci-symptomatic COVID patients.
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Affiliation(s)
- Paolo Romita
- Unit of Dermatology, Department of Precision and Regenerative Medicine and Jonian Area, University of Bari, Bari, Italy -
| | - Carlo A Maronese
- Unit of Dermatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Aurora DE Marco
- Unit of Dermatology, Department of Precision and Regenerative Medicine and Jonian Area, University of Bari, Bari, Italy -
| | | | - Anna Belloni Fortina
- Unit of Pediatric Dermatology, Department of Medicine, University of Padua, Padua, Italy
| | - Valeria Brazzelli
- Institute of Dermatology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Cristiana Colonna
- Unit of Dermatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Vito DI Lernia
- Unit of Dermatology, Arcispedale Santa Maria Nuova, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - May El Hachem
- Unit of Dermatology and Genodermatosis, Division of Genetics and Rare Diseases Research, Bambino Gesù Children's Hospital, Rome, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy -
| | - Caterina Foti
- Unit of Dermatology, Department of Precision and Regenerative Medicine and Jonian Area, University of Bari, Bari, Italy -
| | - Lucretia A Frasin
- Unit of Dermatology, ASTT Lecco, Alessandro Manzoni Hospital, Lecco, Italy
| | - Claudio Guarneri
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Cristina Guerriero
- Institute of Dermatology, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Stefania Guida
- Unit of Dermatology, Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Andrea Locatelli
- Unit of Dermatology, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Iria Neri
- Unit of Dermatology, IRCSS Policlinico di S. Orsola, Bologna, Italy
| | - Corrado Occella
- Unit of Dermatology, Giannina Gaslini Institute, Genoa, Italy
| | | | - Teresa Oranges
- Unit of Dermatology, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Giovanni Pellacani
- Unit of Dermatology, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Giuseppe Stinco
- Department of Experimental and Clinical Medicine, Institute of Dermatology, University of Udine, Udine, Italy
| | - Luca Stingeni
- Section of Dermatology, Department of Medicine, University of Perugia, Perugia, Italy
| | - Tania Barbagallo
- Unit of Dermatology, ASTT Lecco, Alessandro Manzoni Hospital, Lecco, Italy
| | - Anna Campanati
- Dermatological Clinic, Polytechnic Marche University, Ancona, Italy
| | - Serafinella P Cannavò
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesca Caroppo
- Unit of Pediatric Dermatology, Department of Medicine, University of Padua, Padua, Italy
| | - Riccardo Cavalli
- Unit of Dermatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessio Costantini
- Institute of Dermatology, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Rosa Cucchia
- Section of Dermatology, Department of Medicine, University of Perugia, Perugia, Italy
| | - Andrea Diociaiuti
- Unit of Dermatology and Genodermatosis, Division of Genetics and Rare Diseases Research, Bambino Gesù Children's Hospital, Rome, Italy
| | - Cesare Filippeschi
- Unit of Dermatology, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Mariangela Francomano
- Unit of Dermatology, Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Simona Giancristoforo
- Unit of Dermatology and Genodermatosis, Division of Genetics and Rare Diseases Research, Bambino Gesù Children's Hospital, Rome, Italy
| | - Roberta Giuffrida
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Emanuela Martina
- Dermatological Clinic, Polytechnic Marche University, Ancona, Italy
| | - Nicola A Monzani
- Unit of Neonatal Intensive Care, Department of Clinical Sciences and Community Health, IRCCS Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Paola Nappa
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | | | - Annalisa Patrizi
- Unit of Dermatology, IRCSS Policlinico di S. Orsola, Bologna, Italy
| | - Francesca Peccerillo
- Unit of Dermatology, Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Ketty Peris
- Institute of Dermatology, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | | | - Laura Rizzoli
- Division of Dermatology, Santa Chiara Hospital, Trento, Italy
| | - Oriana Simonetti
- Dermatological Clinic, Polytechnic Marche University, Ancona, Italy
| | - Maria Vastarella
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Annalucia Virdi
- Unit of Dermatology, IRCSS Policlinico di S. Orsola, Bologna, Italy
| | - Angelo V Marzano
- Unit of Dermatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Domenico Bonamonte
- Unit of Dermatology, Department of Precision and Regenerative Medicine and Jonian Area, University of Bari, Bari, Italy -
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Starkey SY, Kashetsky N, Lam JM, Dutz J, Mukovozov IM. Chilblain-Like Lesions (CLL) Coinciding With the SARS-CoV-2 Pandemic in Children: A Systematic Review. J Cutan Med Surg 2023. [DOI: 10.1177/12034754231158074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Chilblain-like lesions (CLL) coinciding with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection have been described in the literature. Available reviews of the literature suggest that CLL are associated with younger age, an equal sex ratio, negative testing for SARS-CoV-2, and mild to no extracutaneous manifestations (ECM) associated with COVID-19 infection. This systematic review aims to provide a summary of reports of CLL associated with the early SARS-CoV-2 pandemic in children to clarify the prevalence, clinical characteristics, and resolution outcomes of these skin findings. Sixty-nine studies, published between May 2020 and January 2022, met inclusion criteria and were summarized in this review, representing 1,119 cases of CLL. Available data showed a slight male predominance (591/1002, 59%). Mean age was 13 years, ranging from 0 to 18 years. Most cases had no ECM (682/978, 70%). Overall, 70/507 (14%) of patients tested positive for COVID-19 using PCR and/or serology. In the majority the clinical course was benign with 355/415 (86%) of cases resolving, and 97/269 (36%) resolving without any treatment. This comprehensive summary of pediatric CLL suggests these lesions are rarely associated with COVID-19 symptoms or test positivity.
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Affiliation(s)
- Samantha Y. Starkey
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nadia Kashetsky
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - Joseph M. Lam
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jan Dutz
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
- BC Children’s Hospital Research Institute, British Columbia, Canada
| | - Ilya M. Mukovozov
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
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Martora F, Villani A, Fabbrocini G, Battista T. COVID-19 and cutaneous manifestations: A review of the published literature. J Cosmet Dermatol 2023; 22:4-10. [PMID: 36342945 PMCID: PMC9877578 DOI: 10.1111/jocd.15477] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 10/01/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND COVID-19 is a highly contagious respiratory tract infection caused by severe acute respiratory syndrome coronavirus 2. COVID-19 outbreak, which caused thousands of deaths, has been declared a pandemic by the World Health Organization in March 2020. AIM Skin manifestations related to SARS-CoV-2 infection can be divided mainly into five groups: chilblainlike lesions (CBLLs), maculopapular eruptions, urticarial eruptions, vesicular eruptions, and livedo or necrosis. Other skin findings reported are erythema multiforme (EM)-like lesions and skin findings associated with multisystem inflammatory syndrome in children (MIS-C) and rarely with multisystem inflammatory syndrome in adults (MIS-A). Other manifestations such as pityriasis rosea or shingles are also reported. METHODS A total of 60 articles including reviews, studies and case reports were selected for the evaluation in this review. RESULTS The skin manifestations associated with COVID-19 infection are numerous and can vary widely. The major dermatological patterns of COVID-19 can be classified as inflammatory reactions (maculopapular/morbilliform, urticarial and vesicular rashes), or lesions of vascular origin (chilblain like rashes, petechiae/purpura, and livedo acemose-like pattern) CONCLUSION: We believe that the dermatologist could play an important role in the response to the SARS-CoV-2 pandemic through early recognition of skin lesions suggestive of COVID-19, particularly in paucisymptomatic infections where this recognition could direct toward an early diagnosis of infection that certainly leads to a better prognosis.
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Affiliation(s)
- Fabrizio Martora
- Section of Dermatology – Department of Clinical Medicine and SurgeryUniversity of Naples Federico IINapoliItaly
| | - Alessia Villani
- Section of Dermatology – Department of Clinical Medicine and SurgeryUniversity of Naples Federico IINapoliItaly
| | - Gabriella Fabbrocini
- Section of Dermatology – Department of Clinical Medicine and SurgeryUniversity of Naples Federico IINapoliItaly
| | - Teresa Battista
- Section of Dermatology – Department of Clinical Medicine and SurgeryUniversity of Naples Federico IINapoliItaly
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Arefinia N, Ghoreshi ZA, Alipour AH, Iranmanesh B, Mehrolhasani N, Shamsi‐Meymandi S, Sarvari J. A comprehensive narrative review of the cutaneous manifestations associated with COVID-19. Int Wound J 2022; 20:871-879. [PMID: 36237171 PMCID: PMC9874403 DOI: 10.1111/iwj.13933] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/05/2022] [Accepted: 08/08/2022] [Indexed: 01/27/2023] Open
Abstract
The systemic and respiratory clinical manifestations of coronavirus disease 2019 (COVID-19) include fever, coughing, sneezing, sore throat, rhinitis, dyspnea, chest pain, malaise, fatigue, anorexia and headache. Moreover, cutaneous manifestations have been reported in 0.2% to 20.4% of cases. Early diagnosis of COVID-19 leads to a better prognosis; knowledge of its cutaneous manifestations is one way that may help fulfil this goal. In this review, PubMed and Medline were searched with the terms "dermatology", "skin" and "cutaneous", each in combination with "SARS-CoV-2" or "COVID-19". All articles, including original articles, case reports, case series and review articles published from the emergence of the disease to the time of submission, were included. In this comprehensive narrative review, we tried to provide an analysis of the cutaneous manifestations associated with COVID-19, including maculopapular rash, urticaria, Chilblain-like, vesicular lesions, livedo reticularis and petechiae in asymptomatic/symptomatic COVID-19 patients that might be the first complication of infection after respiratory symptoms. Immune dysregulation, cytokine storms, side effects of antiviral drugs, environmental conditions and high-dose intravenous immunoglobulin (IVIG) therapy might be involved in the pathogenesis of the cutaneous manifestations in COVID-19 patients. Therefore, knowledge of cutaneous COVID-19 manifestations might be vital in achieving a quick diagnosis in some COVID-19 patients, which would help control the pandemic. Further research is very much warranted to clarify this issue.
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Affiliation(s)
- Nasir Arefinia
- Department of Bacteriology and Virology, School of MedicineShiraz University of Medical SciencesShirazIran
| | | | - Amir Hossein Alipour
- Department of Bacteriology and Virology, School of MedicineShiraz University of Medical SciencesShirazIran
| | - Behzad Iranmanesh
- Department of Dermatology, Afzalipour Hospital, Afzalipour Faculty of MedicineKerman University of Medical SciencesKermanIran
| | - Niloofar Mehrolhasani
- Pathology and Stem Cell Research Center, Dermatopathology Department, Afzalipour Teaching HospitalKerman University of Medical SciencesKermanIran
| | - Simin Shamsi‐Meymandi
- Pathology and Stem Cell Research Center, Dermatopathology Department, Afzalipour Teaching HospitalKerman University of Medical SciencesKermanIran
| | - Jamal Sarvari
- Department of Bacteriology and Virology, School of MedicineShiraz University of Medical SciencesShirazIran,Gastroenterohepatology Research CenterShiraz University of Medical SciencesShirazIran
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Dermatological Manifestations of COVID-19 in Children. Indian Pediatr 2022. [PMID: 35273132 PMCID: PMC9160860 DOI: 10.1007/s13312-022-2521-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Context The clinical picture of pediatric severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infection differs from adults as do the cutaneous manifestations. In this review, we summarize the varied morphological manifestations of SARS-CoV-2 infection in the pediatric population. Evidence acquisition A comprehensive literature search was conducted (23 September, 2021) across multiple databases (PubMed, EMBASE, MEDLINE and Cochrane) with the relevant keywords. An additional filter of age group between 0–18 years was kept in each of the searches. Results Chilblains constitute the most common cutaneous manifestation of pediatric coronavirus disease (COVID-19). Other commonly reported manifestations include maculopapular rash, urticaria, erythema multiforme, and papulovesicular eruptions. Majority of children with these manifestations are asymptomatic, highlighting the need to clinically suspect and appropriately manage such patients. A subset of pediatric patients develop severe multisystem involvement termed as multi-system inflammatory syndrome in children (MIS-C) that has varied mucocutaneous manifestations. Conclusion A wide variety of dermatological manifestation of SARS-CoV-2 infection is reported, and both the pediatrician and dermatologist need to be aware of the same to suspect and diagnose COVID-19 infection in children. Electronic Supplementary Material Supplementary material is available in the online version of this article at 10.1007/s13312-022-2521-6.
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Bascuas-Arribas M, Andina-Martinez D, Añon-Hidalgo J, Alonso-Cadenas JA, Hernandez-Martin A, Lamagrande-Casanova N, Noguero-Morel L, Mateos-Mayo A, Colmenero-Blanco I, Torrelo A. Evolution of incidence of chilblain-like lesions in children during the first year of COVID-19 pandemic. Pediatr Dermatol 2022; 39:243-249. [PMID: 35129855 PMCID: PMC9115329 DOI: 10.1111/pde.14948] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 01/18/2022] [Accepted: 01/22/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The COVID-19 pandemic has brought innumerable reports of chilblains. The relation between pernio-like acral eruptions and COVID-19 has not been fully elucidated because most reported cases have occurred in patients with negative microbiological tests for SARS-CoV-2. METHODS A retrospective study of 49 cases of chilblains seen during the first year of the pandemic in a children's hospital in Madrid, Spain. The incidence of these skin lesions was correlated with the number of COVID-19 admissions and environmental temperatures. Patients were separated into two groups depending on the day of onset (strict lockdown period vs. outside the lockdown period). RESULTS Most chilblains cases presented during the first and third waves of the pandemic, paralleling the number of COVID-19 admissions. The first wave coincided with a strict lockdown, and the third wave coincided with the lowest ambient seasonal temperatures of the year. Systemic symptoms preceding chilblains were more frequent in the first wave (45.8% vs. 8.0%, p = .002), as was the co-occurrence with erythema multiforme-like lesions (16.7% vs. 0%, p = .033). Laboratory test and skin biopsies were performed more frequently in the first wave (75.0% vs. 12.0%, p < .001; and 25.0% vs. 0%, p = .007; respectively). Five patients developed recurrent cutaneous symptoms. CONCLUSIONS An increased incidence of chilblains coincided not only with the two major waves of the pandemic, but also with the strict lockdown period in the first wave and low seasonal temperatures during the third wave. Both increased sedentary behaviors and cold environmental temperatures may have played an additive role in the development of COVID-19-related chilblains.
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Affiliation(s)
| | | | - Juan Añon-Hidalgo
- Emergency Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | | | | | - Lucero Noguero-Morel
- Department of Dermatology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Ana Mateos-Mayo
- Department of Dermatology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | - Antonio Torrelo
- Department of Dermatology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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Molaee H, Emadi SN, M'Imunya JMN, Davoudi-Monfared E, Mohammed A, Razavi Z. Chilblain or Perniosis-like Skin Lesions in children during the COVID-19 pandemic: A Systematic Review of Articles. Dermatol Ther 2022; 35:e15298. [PMID: 34981615 DOI: 10.1111/dth.15298] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/24/2021] [Accepted: 12/31/2021] [Indexed: 11/27/2022]
Abstract
COVID toes or chilblain-like skin lesions represent a widespread and specific skin presentation in the feet attributed to COVID-19 infection. They may last for several months. We conducted this study to investigate chilblain-like lesions in children during the COVID-19 pandemic, any predisposition, location, clinical course, and prognosis. We searched Google Scholar, Scopus, and Medline (PubMed) databases using the following keywords: "Coronavirus" OR "COVID-19" AND "Chilblains" OR "Pernio" OR "Perniosis" OR "Children" OR "Cutaneous" OR "skin." The inclusion criteria were: studies that described the specific vascular skin lesion. studies that included patients that were aged > one month till 18 years. . Case reports, case series, retrospective or prospective cohort studies, case-control studies. Twenty-eight articles were included. The total number of children with CLL was 433. The mean age of children presenting CLL during the COVID-19 pandemic was estimated as 12.58 ± 2.15. Of note, 53.6% of them were male. The nasopharyngeal SARS-CoV-2 RT-PCR test and anti-SARS-CoV-2 antibodies were mostly negative for the virus. In conclusion, it is crucial to be familiar with various presentations of COVID-19 infection and their clinical significance to approach the earliest diagnosis, immediate treatment, estimate the prognosis and finally isolate the patients to prevent spreading. Chilblain-like lesions as a possible cutaneous presentation of COVID-19 in children may last several months with the indolent course.
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Affiliation(s)
- Hamideh Molaee
- Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Seyed Naser Emadi
- Skin Research Center of Razi and Imam khomeini hospital, Research Center for War-affected People, Tehran University of Medical Sciences and the Iranian Red Crescent Society, Tehran, Iran
| | | | - Esmat Davoudi-Monfared
- Health Management Research Center, Department of community medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Asha Mohammed
- Public Health department, The Kenya Red Cross Society, Tehran, Iran
| | - Zahra Razavi
- Department of dermatology, Razi hospital, Tehran University of Medical Sciences, Tehran, Iran
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Caselli D, Cafagno C, Loconsole D, Giannini A, Tansella F, Saracino A, Chironna M, Aricò M. Limited Additive Diagnostic Impact of Isolated Gastrointestinal Involvement for the Triage of Children with Suspected COVID-19. CHILDREN 2022; 9:children9010041. [PMID: 35053666 PMCID: PMC8773987 DOI: 10.3390/children9010041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/12/2021] [Accepted: 12/28/2021] [Indexed: 01/08/2023]
Abstract
The strategy for the selection of patients with a suspected SARS-CoV-2 infection is relevant for the organization of a children’s hospital to provide optimal separation into COVID-19 and non-COVID-19 areas and pathways. We analyzed the proportion of children with COVID-19 presenting with gastrointestinal (GI) symptoms in 137 consecutive patients admitted between January 2020 and August 2021. GI symptoms were present as follows: diarrhea in 35 patients (26%), vomiting in 16 (12%), and both of them in five (3%); the combination of fever, respiratory symptoms, and diarrhea was observed in 16 patients (12%). Of the 676 adult patients with COVID-19 admitted to our hospital in the same time interval, 62 (9.2%) had diarrhea, 30 (4.4%) had vomiting, and 11 (1.6%) had nausea; only one patient, a 38-year-old male, presented with isolated GI symptoms at the diagnosis. Although diarrhea was observed in one quarter of cases, one-half of them had the complete triad of fever, respiratory syndrome, and diarrhea, and only five had isolated diarrhea, of which two were diagnosed with a Campylobacter infection. The occurrence of either respiratory symptoms or gastrointestinal symptoms in our patients was not related to the patient age, while younger children were more likely to have a fever. Of the 137 patients, 73 (53%) could be tested for their serum level of SARS-CoV-2 specific IgG antibodies. The observed titer ranged between 0 (n = 3) and 1729 BAU/mL (median, 425 BAU/mL). Of 137 consecutive patients with COVID-19 admitted to our referral children’s hospital, only three presented with an isolated GI manifestation. It is interesting to note that this finding turned out to be fully in keeping with what was observed on adult patients with COVID-19 in our hospital. The additive diagnostic impact of gastrointestinal involvement for the triage of children with suspected COVID-19 appears limited.
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Affiliation(s)
- Désirée Caselli
- Pediatric Infectious Diseases, Giovanni XXIII Children Hospital, Azienda Ospedaliero Universitaria Consorziale Policlinico, 70124 Bari, Italy; (D.C.); (C.C.); (A.G.); (F.T.)
| | - Claudio Cafagno
- Pediatric Infectious Diseases, Giovanni XXIII Children Hospital, Azienda Ospedaliero Universitaria Consorziale Policlinico, 70124 Bari, Italy; (D.C.); (C.C.); (A.G.); (F.T.)
| | - Daniela Loconsole
- Hygiene Section, Department of Biomedical Sciences and Human Oncology, University of Bari, 70124 Bari, Italy; (D.L.); (M.C.)
| | - Annamaria Giannini
- Pediatric Infectious Diseases, Giovanni XXIII Children Hospital, Azienda Ospedaliero Universitaria Consorziale Policlinico, 70124 Bari, Italy; (D.C.); (C.C.); (A.G.); (F.T.)
| | - Francesco Tansella
- Pediatric Infectious Diseases, Giovanni XXIII Children Hospital, Azienda Ospedaliero Universitaria Consorziale Policlinico, 70124 Bari, Italy; (D.C.); (C.C.); (A.G.); (F.T.)
| | - Annalisa Saracino
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari, Azienda Ospedaliero Universitaria Consorziale Policlinico, 70124 Bari, Italy;
| | - Maria Chironna
- Hygiene Section, Department of Biomedical Sciences and Human Oncology, University of Bari, 70124 Bari, Italy; (D.L.); (M.C.)
| | - Maurizio Aricò
- Strategic Control, Azienda Ospedaliero Universitaria Consorziale Policlinico, 70124 Bari, Italy
- Correspondence:
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9
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Fennell J, Onel K. Chilblains-Like Lesions in Pediatric Patients: A Review of Their Epidemiology, Etiology, Outcomes, and Treatment. Front Pediatr 2022; 10:904616. [PMID: 35813389 PMCID: PMC9259963 DOI: 10.3389/fped.2022.904616] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
Vascular pathologies associated with SARS-CoV-2 infection are poorly understood. Color and sensory changes to the extremities, often referred to as "COVID toes" or chilblains-like lesions, have been widely reported in children and adolescents since the onset of the pandemic, raising the concern that they could be a vasculitis secondary to the infection. However, it is unclear if the lesions are a result of the infection or an epiphenomenon. Most literature focuses on adults, and while there are reports on children and adolescents, many of them are small. This review will help medical care providers better understand the epidemiology, etiology, outcomes, and potential treatments for chilblains-like lesions seen in children and adolescents during the pandemic.
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Affiliation(s)
- Jessica Fennell
- Pediatric Rheumatology, Hospital for Special Surgery, New York, NY, United States.,Department of Pediatrics, New York Presbyterian-Weill Cornell, New York, NY, United States
| | - Karen Onel
- Pediatric Rheumatology, Hospital for Special Surgery, New York, NY, United States.,Department of Pediatrics, New York Presbyterian-Weill Cornell, New York, NY, United States
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10
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Sánchez‐García V, Hernández‐Quiles R, de‐Miguel‐Balsa E, Docampo‐Simón A, Belinchón‐Romero I, Ramos‐Rincón J. Are the chilblain-like lesions observed during the COVID-19 pandemic due to severe acute respiratory syndrome coronavirus 2? Systematic review and meta-analysis. J Eur Acad Dermatol Venereol 2022; 36:24-38. [PMID: 34545625 PMCID: PMC8657348 DOI: 10.1111/jdv.17672] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/05/2021] [Accepted: 08/10/2021] [Indexed: 01/07/2023]
Abstract
The expansion of the COVID-19 pandemic has been accompanied by numerous reports of chilblain-like lesions (CLL) in different countries; however, the pathogenesis of these lesions is still unclear. This systematic review and meta-analysis aimed to assess the prevalence of COVID-19 (diagnosed using PCR and/or serology) in patients with CLL. We undertook a literature search in PubMed, Embase, and Scopus (to 15 March 2021), including studies that reported on the number of patients with CLL with positive PCR and/or serology for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or with a clinical suspicion of COVID-19. Regardless of data heterogeneity, a random-effects model was used to pool prevalence estimates. The meta-analysis included 63 original studies, involving 2919 cases of CLL. A subgroup of these patients underwent diagnostic tests for COVID-19 (PCR: n = 1154, 39.5%; serology: n = 943, 32.3%). The pooled prevalence of COVID-19 in the overall sample and in the subgroup who were tested for COVID-19 was, respectively: (i) positive PCR: 2.6% [95% confidence interval (CI) 1.9% to 3.4%] and 5.5% (95% CI, 3.7-7.7%); (ii) positive serology for SARS-CoV-2: 7.2% (95% CI, 4.7-10.2%) and 11.8% (95% CI, 7.9-16.3%); and (iii) positive PCR and/or serology, 15.2% (95% CI, 10.4-20.7%) and 7.5% (95% CI, 5.1-10.3%). Altogether, a small proportion of diagnostic tests for SARS-CoV-2, both PCR and serologies, show positive results in patients with CLL.
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Affiliation(s)
- V. Sánchez‐García
- Dermatology DepartmentAlicante University General Hospital‐ISABIALAlicanteSpain
| | - R. Hernández‐Quiles
- Dermatology DepartmentAlicante University General Hospital‐ISABIALAlicanteSpain
| | - E. de‐Miguel‐Balsa
- Intensive Care DepartmentElche University General HospitalAlicanteSpain
- Clinical Medicine DepartmentUniversity Miguel Hernández of ElcheAlicanteSpain
| | - A. Docampo‐Simón
- Dermatology DepartmentAlicante University General Hospital‐ISABIALAlicanteSpain
| | - I. Belinchón‐Romero
- Dermatology DepartmentAlicante University General Hospital‐ISABIALAlicanteSpain
- Clinical Medicine DepartmentUniversity Miguel Hernández of ElcheAlicanteSpain
| | - J.M. Ramos‐Rincón
- Clinical Medicine DepartmentUniversity Miguel Hernández of ElcheAlicanteSpain
- Internal Medicine DepartmentAlicante University General Hospital‐ISABIALAlicanteSpain
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11
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Clinicopathologic features among different viral epidemic outbreaks involving the skin. Clin Dermatol 2022; 40:573-585. [PMID: 36509508 PMCID: PMC8219845 DOI: 10.1016/j.clindermatol.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The current coronavirus disease 2019 pandemic has exceeded any epidemiologic prevision, but increasing information suggests some analogies with the major viral outbreaks in the last century, and a general warning has been issued on the possibility that coinfections can make the differential diagnosis and treatment difficult, especially in tropical countries. Some reports have noted that the presence of high dengue antibodies can give a false-negative result when testing for severe acute respiratory syndrome coronavirus 2. Mucocutaneous manifestations are very frequent, with an apparent overlap among different pathogens. However, strong clinicopathologic correlation might provide some clues to address differentials. Waiting for laboratory and instrumental results, the timing and distribution of skin lesions is often pathognomonic. Histopathologic findings characterize certain reaction patterns and provide insights on pathogenetic mechanisms. Unfortunately, skin assessment, especially invasive examinations such as biopsy, takes a back seat in severely ill patients. A literature retrieval was performed to collect information from other epidemics to counteract what has become the most frightening disease of our time.
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Key Words
- (covid-19), coronavirus 2019 disease
- (who), world health organization
- (sars), severe acute respiratory syndrome coronavirus
- (sars-cov-2), novel coronavirus
- (mers), middle east respiratory syndrome
- (r0), basic reproductive number
- (mis), multisystem inflammatory syndrome
- (iga), immunoglobulin a
- (ace-2), angiotensin‐converting enzyme 2
- (dengv), dengue virus
- (ttp), thrombotic thrombocytopenic purpura
- (vwf), von willebrand factor
- (cd1a), cluster of diffentiation 1-a
- (rt-pcr), reverse transcription polymerase chain reaction
- (chikv), chikungunya virus
- (e1, e2), envelope glycoprotein
- (ifn-i), interferon-type-i
- (zikv), zika virus
- (ebov), ebola virus
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12
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Young EM. Perinatal/maternal-fetal-infant dermatologic manifestations of SARS-CoV-2. An Overview and Implications for diagnosis, treatment, and prognosis. Front Pediatr 2022; 10:1071839. [PMID: 36533244 PMCID: PMC9755859 DOI: 10.3389/fped.2022.1071839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 10/24/2022] [Indexed: 12/05/2022] Open
Abstract
Early identification of the dermatologic manifestations of SARS-CoV-2 in perinatal and maternal-fetal-infant populations is essential for early intervention in the diagnosis, treatment, and prevention of short and long term sequelae. Although cutaneous signs of SARS-CoV-2 are less common in pregnant women, neonates, and infants, the recognition of related skin lesions with regard to timing, location, duration, and pattern can lead to determining disease severity. While many pediatric patients may be asymptomatic with negative SARS-CoV-2 testing, skin lesions may be the only clue of infection. SARS-CoV-2 infection in pregnancy can lead to severe life threatening illness and by understanding the cutaneous manifestations associated with SARS-CoV-2 infection, early diagnosis can be made with improved maternal-fetal outcomes. A wide array of dermatologic presentations associated with SARS-CoV-2 are reported in the literature. This review explores the expanding reports in the literature of the dermatologic presentations of skin lesions related to SARS-CoV-2 specifically in perinatal and maternal-fetal-infant health and the implications for management. The collaboration of the specialties of dermatology, pediatrics, obstetrics/gynecology, and infectious disease in the approach to SARS-CoV-2 disease can lead to a better understanding of the scope and presentation of this disease.
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Affiliation(s)
- Elaine M Young
- Adult and Pediatric Dermatology, Private Practice, Huntington, WV, United States.,Department of Internal Medicine, Joan C. Edwards School of Medicine, Huntington, WV, United States
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13
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Abstract
Dermatologists reported an outbreak of pernio (red to purple swollen painful toes) during the COVID-19 pandemic. Most subjects lacked positive CoV-19 polymerase chain reaction (PCR) or antibodies or a preceding illness. The dermatologists termed the illness "COVID toes." Pernio usually affects adults versus "COVID toes" usually children. Pernio is preceded by a clear history of exposure to wet and cold. Patients with "COVID toes" lack this history. Also, it is not unusual for multiple family members to have "COVID toes." Our case report describes "COVID toes" in an 18-year-old with no preceding illness, a negative SARS-CoV-19 PCR, and an initially negative SARS-CoV-19 antibody, and also his 2 siblings also developed "COVID toes." In our index case, repeat SARS-CoV-19 antibodies were positive. Seroconversion has rarely been reported in patients with "COVID toes." Why most "COVID toes" patients lack a clinical history of COVID-19 and are SARS-CoV-19 PCR and antibody negative is a mystery.
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14
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Atzori L, Ferreli C, Mateeva V, Vassileva S, Rongioletti F. Clinicopathologic features between different viral epidemic outbreaks involving the skin. Clin Dermatol 2021; 39:405-417. [PMID: 34517998 PMCID: PMC8071581 DOI: 10.1016/j.clindermatol.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The current coronavirus disease 2019 pandemic has exceeded any epidemiologic prevision, but increasing information suggests some analogies with the major viral outbreaks of the last century. A general warning has been issued on the possibility that coinfections can make differential diagnosis and treatment difficult, especially in tropical countries. Some reports have pointed out that the presence of high Dengue antibodies can give a false-negative result for severe acute respiratory syndrome coronavirus 2. Mucocutaneous manifestations are very frequent, with an apparent overlap among different pathogens. A strong clinicopathologic correlation, however, may provide some clues to address the differential. Waiting for laboratory and instrumental results, the timing and distribution of skin lesions is often pathognomonic. Histopathologic findings characterize certain reaction patterns and provide insights on pathogenetic mechanisms. Unfortunately, skin assessments, especially invasive exams such as biopsy, are less important in severely ill patients. A literature review was performed to collect information from other epidemics to counteract what has become the most frightening disease of our time.
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Affiliation(s)
- Laura Atzori
- Dermatology Clinic, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Caterina Ferreli
- Dermatology Clinic, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
| | - Valeria Mateeva
- Department of Dermatology, Sofia University of Medicine, Sofia, Bulgaria
| | - Snejina Vassileva
- Department of Dermatology, Sofia University of Medicine, Sofia, Bulgaria
| | - Franco Rongioletti
- Dermatology Clinic, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Vita-SaluteS.Raffaele University, Milan, Italy
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15
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Abstract
An increasing body of evidence has been produced in a very limited period to improve the understanding of skin involvement in the current coronavirus 2019 disease pandemic, and how this novel disease affects the management of dermatologic patients. A little explored area is represented by the therapeutic approach adopted for the different skin manifestations associated with the infection. An overview of the current scenario is provided, through review of the English-language literature published until October 30, 2020, and comparison with the personal experience of the authors. As dermatologists, our primary aim is to support patients with the highest standard of care and relieve suffering, even with lesions not life-threatening. With asymptomatic COVID-19 patients, patient discomfort related to skin lesions should not be undervalued and intervention to accelerate healing should be provided. Consensus protocols are warranted to assess the best skin-targeted treatments in COVID-19 patients.
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Affiliation(s)
- Laura Atzori
- Dermatology Clinic, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Sebastiano Recalcati
- Dermatology Unit, Azienda Socio Sanitaria Territoriale (ASST) Lecco, Alessandro Manzoni Hospital, Lecco, Italy
| | - Caterina Ferreli
- Dermatology Clinic, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
| | | | - Franco Rongioletti
- Dermatology Clinic, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Vita-Salute University and Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele, Milan, Italy
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16
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Lim RK, Kalagara S, Chen KK, Mylonakis E, Kroumpouzos G. DERMATOLOGY IN A MULTIDISCIPLINARY APPROACH WITH INFECTIOUS DISEASE AND OBSTETRIC MEDICINE AGAINST COVID-19. Int J Womens Dermatol 2021; 7:640-646. [PMID: 34462725 PMCID: PMC8388141 DOI: 10.1016/j.ijwd.2021.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/21/2021] [Accepted: 08/22/2021] [Indexed: 12/27/2022] Open
Abstract
The care for patients infected with COVID-19 requires a team approach, and dermatologists may collaborate with other specialties, especially infectious disease (ID) medicine and obstetrics and gynecology (ObGyn), at every stage of the infection process. A broad spectrum of cutaneous manifestations may occur early in COVID-19 infection, making appropriate dermatologic identification critical for an early diagnosis. There is prognostic value in appropriately identifying different types of COVID-19–associated skin manifestations, which have been linked to disease severity. Such observations emanated from dermatology research, especially large series and international registries of cutaneous manifestations relating to COVID-19, and impact COVID-19 care provided by most health care providers. Also, research based on international registries of skin reactions from the COVID-19 vaccines has an impact across disciplines. An increased risk for severe illness from COVID-19 is encountered during pregnancy, and dermatologists’ role is to urge ObGyn and other clinicians to monitor and educate pregnant patients about the potential for eruptions as a manifestation of COVID-19. ID and ObGyn experts indicate that teledermatology enhanced the interaction among health care providers and improved COVID-19 care. More than 40% of all dermatology consultations at a tertiary care hospital were done via teledermatology. Future collaborative research involving dermatology and specialties, such as ID and ObGyn, could help delineate guidelines for dermatology consultations in patients infected with COVID-19 and determine cases appropriate for teledermatology.
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Affiliation(s)
- Rachel K. Lim
- Alpert Medical School at Brown University, Providence, Rhode Island
| | - Saisanjana Kalagara
- Division of Infectious Diseases, Alpert Medical School at Brown University, Providence, Rhode Island
| | - Kenneth K. Chen
- Division of Obstetric and Consultative Medicine, Alpert Medical School at Brown University, Providence, Rhode Island
| | - Eleftherios Mylonakis
- Division of Infectious Diseases, Alpert Medical School at Brown University, Providence, Rhode Island
| | - George Kroumpouzos
- Department of Dermatology, Alpert Medical School at Brown University, Providence, Rhode Island
- Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil
- GK Dermatology, PC, S Weymouth, Massachusetts
- Corresponding Author.
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17
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Discepolo V, Catzola A, Pierri L, Mascolo M, Della Casa F, Vastarella M, Smith G, Travaglino A, Punziano A, Nappa P, Staibano S, Bruzzese E, Fabbrocini G, Guarino A, Alessio M. Bilateral Chilblain-like Lesions of the Toes Characterized by Microvascular Remodeling in Adolescents During the COVID-19 Pandemic. JAMA Netw Open 2021; 4:e2111369. [PMID: 34110396 PMCID: PMC8193438 DOI: 10.1001/jamanetworkopen.2021.11369] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
IMPORTANCE Chilblain-like lesions have been one of the most frequently described cutaneous manifestations during the COVID-19 pandemic. Their etiopathogenesis, including the role of SARS-CoV-2, remains elusive. OBJECTIVE To examine the association of chilblain-like lesions with SARS-CoV-2 infection. DESIGN, SETTING, AND PARTICIPANTS This prospective case series enrolled 17 adolescents who presented with chilblain-like lesions from April 1 to June 30, 2020, at a tertiary referral academic hospital in Italy. MAIN OUTCOMES AND MEASURES Macroscopic (clinical and dermoscopic) and microscopic (histopathologic) analysis contributed to a thorough understanding of the lesions. Nasopharyngeal swab, serologic testing, and in situ hybridization of the skin biopsy specimens were performed to test for SARS-CoV-2 infection. Laboratory tests explored signs of systemic inflammation or thrombophilia. Structural changes in peripheral microcirculation were investigated by capillaroscopy. RESULTS Of the 17 adolescents (9 [52.9%] male; median [interquartile range] age, 13.2 [12.5-14.3] years) enrolled during the first wave of the COVID-19 pandemic, 16 (94.1%) had bilaterally localized distal erythematous or cyanotic lesions. A triad of red dots (16 [100%]), white rosettes (11 [68.8%]), and white streaks (10 [62.5%]) characterized the dermoscopic picture. Histologic analysis revealed a remodeling of the dermal blood vessels with a lobular arrangement, wall thickening, and a mild perivascular lymphocytic infiltrate. SARS-CoV-2 infection was excluded by molecular and serologic testing. In situ hybridization did not highlight the viral genome in the lesions. CONCLUSIONS AND RELEVANCE This study delineated the clinical, histologic, and laboratory features of chilblain-like lesions that emerged during the COVID-19 pandemic, and its findings do not support their association with SARS-CoV-2 infection. The lesions occurred in otherwise healthy adolescents, had a long but benign course to self-resolution, and were characterized by a microvascular remodeling with perivascular lymphocytic infiltrate but no other signs of vasculitis. These results suggest that chilblain-like lesions do not imply a concomitant SARS-CoV-2 infection. Ongoing studies will help clarify the etiopathogenic mechanisms.
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Affiliation(s)
- Valentina Discepolo
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Andrea Catzola
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Luca Pierri
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Massimo Mascolo
- Department of Advanced Biomedical Sciences, Pathology Unit, University of Naples Federico II, Naples, Italy
| | - Francesca Della Casa
- Department of Translational Medical Sciences, Section of Clinical Immunology, University of Naples Federico II, Naples, Italy
| | - Maria Vastarella
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | - Grace Smith
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Antonio Travaglino
- Department of Advanced Biomedical Sciences, Pathology Unit, University of Naples Federico II, Naples, Italy
| | - Alessandra Punziano
- Department of Translational Medical Sciences, Section of Clinical Immunology, University of Naples Federico II, Naples, Italy
| | - Paola Nappa
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | - Stefania Staibano
- Department of Advanced Biomedical Sciences, Pathology Unit, University of Naples Federico II, Naples, Italy
| | - Eugenia Bruzzese
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Gabriella Fabbrocini
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | - Alfredo Guarino
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Maria Alessio
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
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18
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Singh H, Kaur H, Singh K, Sen CK. Cutaneous Manifestations of COVID-19: A Systematic Review. Adv Wound Care (New Rochelle) 2021; 10:51-80. [PMID: 33035150 PMCID: PMC8020517 DOI: 10.1089/wound.2020.1309] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 09/16/2020] [Indexed: 01/08/2023] Open
Abstract
Objective: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is currently a pandemic. Although pulmonary health has been the primary focus of studies during the early days of COVID-19, development of a comprehensive understanding of this emergent disease requires knowledge of all possible disease manifestations in affected patients. This Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant review focuses on cutaneous manifestations reported in COVID-19 patients. Approach: Literature review was conducted using the PubMed database to examine various cutaneous manifestations related to the SARS-CoV-2 infection. Published articles (n = 56) related to search criteria from the onset of the COVID-19 pandemic to June 30, 2020, were included. The primary literature articles included in this study were mainly from France, Spain, Italy, and the United Kingdom. Results: Unique to many other symptoms of COVID-19, its cutaneous manifestations have been found in people of all age groups, including children. The cutaneous manifestations of COVID-19 are varied and include maculopapular, chilblain-like, urticarial, vesicular, livedoid, and petechial lesions. In addition, rashes are common in multisystem inflammatory syndrome in children, a new and serious health condition that shares symptoms with Kawasaki disease and is likely related to COVID-19. In addition, personal protective equipment-related skin wounds are of serious concern since broken cutaneous barriers can create an opening for potential COVID-19 infections. Innovation and Conclusion: As this virus continues to spread silently, mainly through asymptomatic carriers, an accurate and rapid identification of these cutaneous manifestations may be vital to early diagnosis and lead to possible better prognosis in COVID-19 patients. This systematic review and photo atlas provide a detailed analysis of the skin pathologies related to COVID-19. Study of these cutaneous manifestations and their pathogenesis, as well their significance in human health will help define COVID-19 in its entirety, which is a prerequisite to its effective management.
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Affiliation(s)
- Harjas Singh
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Harleen Kaur
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Kanhaiya Singh
- Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Surgery, Indiana University Health Comprehensive Wound Center, and Indiana Center for Regenerative Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Chandan K. Sen
- Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Surgery, Indiana University Health Comprehensive Wound Center, and Indiana Center for Regenerative Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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19
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Baeck M, Herman A. COVID toes: where do we stand with the current evidence? Int J Infect Dis 2021; 102:53-55. [PMID: 33075530 PMCID: PMC7566763 DOI: 10.1016/j.ijid.2020.10.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/05/2020] [Accepted: 10/08/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Numerous of cases of chilblains have been observed, mainly in young subjects with no or mild symptoms compatible with COVID-19. The pathophysiology of these lesions is still widely debated and an association with SARS-CoV-2 infection remains unconfirmed. OBJECTIVES This paper focus on the unresolved issues about these COVID toes and in particular whether or not they are associated with COVID-19. ARGUMENTS The temporal link between the outbreak of chilblains and the COVID-19 pandemic is a first suggests a link between the two events. Positive anti-SARS-CoV/SARS-CoV-2 immunostaining on skin biopsy of chilblains seem to confirm the presence of the virus in the lesions, but lack specificity and must be interpreted with caution. Conversely, RT-PCR and anti-SARS-CoV-2 serology were negative in the majority of patients with chilblains. Therefore, SARS-CoV-2 infection can be excluded, with relative certainty, even after accounting for possible lower immunization in mild/asymptomatic patients and for some differences in sensitivity/specificity between the tests used. Some authors hypothesize that chilblains could be the cutaneous expression of a strong type I interferon (IFN-I) response. High production of IFN-I is suggested to be associated with early viral control and may suppress antibody response. However, the absence of other cutaneous or extracutaneous symptoms as observed in other interferonopathies raises unanswered questions. To date, a direct link between chilblains and COVID-19 still seems impossible to confirm. A more indirect association due to lifestyle changes induced by lockdown is a possible explanation. Improvement of chilblains when protective measures were adopted and after lifting of lockdown, support this hypothesis. CONCLUSION Conflicting current evidence highlights the need for systematic and repeated testing of larger numbers of patients and the need for valid follow-up data that take into consideration epidemic curves and evolution of lockdown measures.
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Affiliation(s)
- Marie Baeck
- Department of Dermatology, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Avenue Hippocrate 10, 1200, Brussels, Belgium.
| | - Anne Herman
- Department of Dermatology, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Avenue Hippocrate 10, 1200, Brussels, Belgium.
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20
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Rongioletti F, Ferreli C, Sena P, Caputo V, Atzori L. Clinicopathologic correlations of COVID-19-related cutaneous manifestations with special emphasis on histopathologic patterns. Clin Dermatol 2021; 39:149-162. [PMID: 33972045 PMCID: PMC7832768 DOI: 10.1016/j.clindermatol.2020.12.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Skin is one of target organs affected by the novel coronavirus SARS-CoV-2, and in response to the current COVID-19 pandemic, a fast body of literature has emerged on related cutaneous manifestations. Current perspective is that the skin is not only a bystander of the general cytokines storm with thrombophilic multiorgan injury, but it is directly affected by the epithelial tropism of the virus, as confirmed by the detection of SARS-CoV-2 in endothelial cells and epithelial cells of epidermis and eccrine glands. In contrast with the abundance of epidemiologic and clinical reports, histopathologic characterization of skin manifestations is limited. Without an adequate clinicopathologic correlation, nosology of clinically similar conditions is confusing, and effective association with COVID-19 remains presumptive. Several patients with different types of skin lesions, including the most specific acral chilblains-like lesions, showed negative results at SARS-CoV-2 nasopharyngeal and serologic sampling. The aim of this review is to provide an overview of what has currently been reported worldwide, with a particular emphasis on microscopic patterns of the skin manifestations in patients exposed to or affected by COVID-19. Substantial breakthroughs may occur in the near future from more skin biopsies, improvement of immunohistochemistry studies, RNA detection of SARS-CoV-2 strain by real-time polymerase chain reaction-based assay, and electron microscopic studies.
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Affiliation(s)
- Franco Rongioletti
- Unit of Dermatology, Department Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; IRCCS San Raffaele Hospital and Dental School, Vita Salute University, 20132 Milan, Italy
| | - Caterina Ferreli
- Unit of Dermatology, Department Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
| | - Paolo Sena
- Unit of Dermatology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Valentina Caputo
- Unit of Pathology, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Laura Atzori
- Unit of Dermatology, Department Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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21
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Grover C, Gaurav V. ”COVID” terminology in dermatology. Indian J Dermatol 2021; 66:705. [PMID: 35283498 PMCID: PMC8906297 DOI: 10.4103/ijd.ijd_472_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Ever since the beginning of COVID-19 pandemic, mucocutaneous manifestations started being noticed and are still being documented. Many of these have been described with the prefix “COVID” and may occur due to the infection (e.g., COVID rash), use of personal protective equipment in healthcare workers (e.g., COVID hand dermatitis) or extensive use of novel vaccines (e.g., COVID arm). This article attempts to summarize such entities with clinical relevance to dermatologists and physicians in general and to create awareness about this fast-evolving COVID lexicon.
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22
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Burlando M, Russo R, Cozzani E, Parodi A. Six months into the pandemic. A review of skin manifestations in SARS-CoV-2 infection. Dermatol Ther 2021; 34:e14641. [PMID: 33278049 PMCID: PMC7883133 DOI: 10.1111/dth.14641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/21/2020] [Accepted: 12/02/2020] [Indexed: 01/08/2023]
Abstract
During the COVID-19 pandemic, various cutaneous manifestations have been described as associated with SARS-CoV2 infection. It is debated if skin lesions could represent a diagnostic or prognostic indicator. Specifically, it is unclear whether skin lesions may be used to perform an early diagnosis and/or to predict worse outcomes. In this review, we described the cutaneous signs so far reported as COVID-19-related and discussed their incidence, clinico-pathological features, and diagnostic and prognostic value.
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Affiliation(s)
- Martina Burlando
- Department of DermatologyUniversity of GenoaGenoaItaly
- Department of DermatologyIRCCS San Martino Polyclinic HospitalGenoaItaly
| | - Roberto Russo
- Department of DermatologyUniversity of GenoaGenoaItaly
- Department of DermatologyIRCCS San Martino Polyclinic HospitalGenoaItaly
| | - Emanuele Cozzani
- Department of DermatologyUniversity of GenoaGenoaItaly
- Department of DermatologyIRCCS San Martino Polyclinic HospitalGenoaItaly
| | - Aurora Parodi
- Department of DermatologyUniversity of GenoaGenoaItaly
- Department of DermatologyIRCCS San Martino Polyclinic HospitalGenoaItaly
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Khalili M, Iranmanesh B, Mohammadi S, Aflatoonian M. Cutaneous and histopathological features of coronavirus disease 2019 in pediatrics: A review article. Dermatol Ther 2020; 34:e14554. [PMID: 33210417 PMCID: PMC7744858 DOI: 10.1111/dth.14554] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/07/2020] [Accepted: 11/11/2020] [Indexed: 12/25/2022]
Abstract
Prevalence of dermatological manifestations of coronavirus disease 2019 (COVID‐19) is estimated between 0.25% and 3% in children and adolescents. In this review article, we decided to describe the cutaneous and histopathological manifestations of COVID‐19 infection in pediatrics. We searched published articles in PubMed database for key words of “children” or “pediatric” and “cutaneous” or “dermatology” or “skin” and “COVID‐19” or “SARS‐CoV‐2” or “Coronavirus disease 2019” in abstract or title from December of 2019 until September 2020. Finally, 38 articles were selected. The majority of patients were between 11 and 17 years old with predominantly male gender. Most of the patients were either asymptomatic or had a few general symptoms. The latency time from appearance of general symptoms to cutaneous ones was between 1 day and weeks. Skin lesions faded between 3 and 88 days without any sequelae, spontaneously or with either topical or systemic corticosteroids. Skin manifestations were chilblain‐like (pseudochilblain), erythema multiforme‐like, dactylitis, acral erythema, acute urticaria, livedo reticularis, mottling, acro‐ischemia, generalized maculopapular lesions, eyelid dermatitis, miliaria‐like, varicelliform lesions, and petechiae and/or purpura. Kawa‐COVID‐19 patients were presented more frequently with cardiogenic shock, neurological symptoms, lymphocytopenia, and thrombocytopenia as compared to classic Kawasaki's disease. Furthermore, more number of cases were resistant to the first‐line treatments.
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Affiliation(s)
- Maryam Khalili
- Department of Dermatology, Kerman University of Medical Sciences, Kerman, Iran
| | - Behzad Iranmanesh
- Department of Dermatology, Kerman University of Medical Sciences, Kerman, Iran
| | - Saman Mohammadi
- Department of Dermatology, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahin Aflatoonian
- Leishmaniasis Research Center, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
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24
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Recalcati S, Tonolo S, Luzzaro F, Fantini F. Response to 'No evidence of SARS-CoV-2 infection by polymerase chain reaction or serology in children with pseudo-chilblain'. Br J Dermatol 2020; 183:1154-1156. [PMID: 32880906 PMCID: PMC7461372 DOI: 10.1111/bjd.19493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/13/2020] [Accepted: 08/13/2020] [Indexed: 11/30/2022]
Abstract
Linked Article: Caselli et al. Br J Dermatol 2020; 183:784–785.
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Affiliation(s)
- S Recalcati
- Dermatology Unit, ASST Lecco, Alessandro Manzoni Hospital, Lecco, Italy
| | - S Tonolo
- Microbiology and Virology Unit, ASST Lecco, Alessandro Manzoni Hospital, Lecco, Italy
| | - F Luzzaro
- Microbiology and Virology Unit, ASST Lecco, Alessandro Manzoni Hospital, Lecco, Italy
| | - F Fantini
- Dermatology Unit, ASST Lecco, Alessandro Manzoni Hospital, Lecco, Italy
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25
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Genovese G, Moltrasio C, Berti E, Marzano AV. Skin Manifestations Associated with COVID-19: Current Knowledge and Future Perspectives. Dermatology 2020; 237:1-12. [PMID: 33232965 PMCID: PMC7801998 DOI: 10.1159/000512932] [Citation(s) in RCA: 142] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/10/2020] [Indexed: 11/28/2022] Open
Abstract
Background Coronavirus disease-19 (COVID-19) is an ongoing global pandemic caused by the “severe acute respiratory syndrome coronavirus 2” (SARS-CoV-2), which was isolated for the first time in Wuhan (China) in December 2019. Common symptoms include fever, cough, fatigue, dyspnea and hypogeusia/hyposmia. Among extrapulmonary signs associated with COVID-19, dermatological manifestations have been increasingly reported in the last few months. Summary The polymorphic nature of COVID-19-associated cutaneous manifestations led our group to propose a classification, which distinguishes the following six main clinical patterns: (i) urticarial rash, (ii) confluent erythematous/maculopapular/morbilliform rash, (iii) papulovesicular exanthem, (iv) chilblain-like acral pattern, (v) livedo reticularis/racemosa-like pattern, (vi) purpuric “vasculitic” pattern. This review summarizes the current knowledge on COVID-19-associated cutaneous manifestations, focusing on clinical features and therapeutic management of each category and attempting to give an overview of the hypothesized pathophysiological mechanisms of these conditions.
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Affiliation(s)
- Giovanni Genovese
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Chiara Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Emilio Berti
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy, .,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy,
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Caselli D, Chironna M, Loconsole D, Aricò M. Response to 'No evidence of SARS-CoV-2 infection by polymerase chain reaction or serology in children with pseudo-chilblain'. Reply from the authors. Br J Dermatol 2020; 183:1156-1157. [PMID: 32974916 PMCID: PMC7537176 DOI: 10.1111/bjd.19563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- D Caselli
- Pediatric Infectious Diseases, Azienda, Piazza G., 70124, Bari, Italy
| | - M Chironna
- Department of Biomedical Sciences and Human Oncology-Hygiene Section, University of Bari, Piazza G. Cesare 11, 70124, Bari, Italy
| | - D Loconsole
- Department of Biomedical Sciences and Human Oncology-Hygiene Section, University of Bari, Piazza G. Cesare 11, 70124, Bari, Italy
| | - M Aricò
- COVID Emergency Task Force, Giovanni XXIII Children's Hospital, Azienda Ospedaliero Universitaria, Consorziale Policlinico, Bari, Piazza G. Cesare 11, 70124, Bari, Italy
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SARS-CoV-2 Infection in Children in Southern Italy: A Descriptive Case Series. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176080. [PMID: 32825563 PMCID: PMC7504571 DOI: 10.3390/ijerph17176080] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 12/24/2022]
Abstract
At the beginning of the coronavirus-2019 (COVID-19) pandemic, Italy was one of the most affected countries in Europe. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection is less frequent and less severe in children than in adults. This study analyzed the frequency of SARS-CoV-2 infection among all children aged <18 years in the Apulia region of southern Italy and the characteristics of the infected children. Clinical and demographic data were collected through the national platform for COVID-19 surveillance. Of the 166 infected children in the Apulia region, 104 (62.6%) were asymptomatic, 37 (22.3%) had mild infections, 22 (13.3%) had moderate infections, and 3 (1.8%) had severe infections. Only ten children (6.0%) were hospitalized, but none required intensive care support and none died. SARS-CoV-2 infection was transmitted mainly from parents or relatives to children. Because of school closure during the lockdown, infection was unlikely to have been transmitted among children. It is unclear whether school reopening would enhance virus spread, leading the Italian government to develop guidelines for safe school reopening. The actual role of children in virus transmission remains unclear. A sensitive surveillance system, prompt identification of cases, testing, and contact tracing will be key to reducing the further spread of infection.
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