Chilblains and Covid-19 (Covid Toes)

NewsBot · Oct 5, 2021

Are the chilblain-like lesions observed during the COVID-19 pandemic due to SARS-CoV-2? Systematic review and meta-analysis
V Sánchez-García et al
J Eur Acad Dermatol Venereol. 2021 Sep 21

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 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: (a) positive PCR: 2.6% (95% confidence interval [CI] 1.9% to 3.4%) and 5.5% (95% CI 3.7% to 7.7%); (b) positive serology for SARS-CoV-2: 7.2% (95% CI 4.7% to 10.2%) and 11.8% (95% CI 7.9% to 16.3%); and (c) positive PCR and/or serology, 15.2% (95% CI 10.4% to 20.7%) and 7.5% (95% CI 5.1% to 10.3%). Altogether, a small proportion of diagnostic tests for SARS-CoV-2, both PCR and serologies, show positive results in patients with CLL.
Click to expand...

NewsBot · Oct 6, 2021

Study reveals why some people get Covid toe condition

NewsBot · Oct 6, 2021

Type I interferon response and vascular alteration in chilblain-like lesions during the COVID-19 outbreak
L. Frumholtz,J.-D. Bouaziz,M. Battistella,J. Hadjadj,R. Chocron,D. Bengoufa,H. Le Buanec,L. Barnabei,S. Meynier,O. Schwartz,L. Grzelak,N. Smith,B. Charbit,D. Duffy,N. Yatim, … See all authors
British Journal of Dermatology: 05 October 2021

Background
The outbreak of chilblain-like lesions (CLL) during the COVID-19 pandemic has been reported extensively, potentially related to SARS-CoV-2 infection, yet its underlying pathophysiology is unclear.

Objectives
To study skin and blood endothelial and immune system activation in CLL in comparison with healthy controls and seasonal chilblains (SC), defined as cold-induced sporadic chilblains occurring during 2015 and 2019 with exclusion of chilblain lupus.

Methods
This observational study was conducted during 9–16 April 2020 at Saint-Louis Hospital, Paris, France. All patients referred with CLL seen during this period of the COVID-19 pandemic were included in this study. We excluded patients with a history of chilblains or chilblain lupus. Fifty patients were included.

Results
Histological patterns were similar and transcriptomic signatures overlapped in both the CLL and SC groups, with type I interferon polarization and a cytotoxic–natural killer gene signature. CLL were characterized by higher IgA tissue deposition and more significant transcriptomic activation of complement and angiogenesis factors compared with SC. We observed in CLL a systemic immune response associated with IgA antineutrophil cytoplasmic antibodies in 73% of patients, and elevated type I interferon blood signature in comparison with healthy controls. Finally, using blood biomarkers related to endothelial dysfunction and activation, and to angiogenesis or endothelial progenitor cell mobilization, we confirmed endothelial dysfunction in CLL.

Conclusions
Our findings support an activation loop in the skin in CLL associated with endothelial alteration and immune infiltration of cytotoxic and type I IFN-polarized cells leading to clinical manifestations.
Click to expand...

NewsBot · Oct 11, 2021

Type I interferon response and vascular alteration in chilblain-like lesions during the COVID-19 outbreak
L. Frumholtz,J.-D. Bouaziz,M. Battistella,J. Hadjadj,R. Chocron,D. Bengoufa,H. Le Buanec,L. Barnabei,S. Meynier,O. Schwartz,L. Grzelak,N. Smith,B. Charbit,D. Duffy,N. Yatim,
05 October 2021

Background
The outbreak of chilblain-like lesions (CLL) during the COVID-19 pandemic has been reported extensively, potentially related to SARS-CoV-2 infection, yet its underlying pathophysiology is unclear.

Objectives
To study skin and blood endothelial and immune system activation in CLL in comparison with healthy controls and seasonal chilblains (SC), defined as cold-induced sporadic chilblains occurring during 2015 and 2019 with exclusion of chilblain lupus.

Methods
This observational study was conducted during 9–16 April 2020 at Saint-Louis Hospital, Paris, France. All patients referred with CLL seen during this period of the COVID-19 pandemic were included in this study. We excluded patients with a history of chilblains or chilblain lupus. Fifty patients were included.

Results
Histological patterns were similar and transcriptomic signatures overlapped in both the CLL and SC groups, with type I interferon polarization and a cytotoxic–natural killer gene signature. CLL were characterized by higher IgA tissue deposition and more significant transcriptomic activation of complement and angiogenesis factors compared with SC. We observed in CLL a systemic immune response associated with IgA antineutrophil cytoplasmic antibodies in 73% of patients, and elevated type I interferon blood signature in comparison with healthy controls. Finally, using blood biomarkers related to endothelial dysfunction and activation, and to angiogenesis or endothelial progenitor cell mobilization, we confirmed endothelial dysfunction in CLL.

Conclusions
Our findings support an activation loop in the skin in CLL associated with endothelial alteration and immune infiltration of cytotoxic and type I IFN-polarized cells leading to clinical manifestations.
Click to expand...

NewsBot · Oct 11, 2021

Chilblains during lockdown are associated with household exposure to SARS-CoV-2. A multicentre case-control study
Florence Poizeau et al
Clin Microbiol Infect. 2021 Oct 4

During the COVID-19 pandemic, numerous cases of chilblains have been reported. However, in most cases, RT-PCR or serology did not confirm SARS-CoV-2 infection. Hypotheses have been raised about an interferon-mediated immunological response to SARS-CoV-2, leading to effective clearance of the SARS-CoV-2 without the involvement of humoral immunity. Our objective was to explore the association between chilblains and exposure to SARS-CoV-2.

Methods
In this multicentre case-control study, cases were the 102 individuals referred to 5 referral hospitals for chilblains occurring during the first lockdown (March to May 2020). Controls were recruited from healthy volunteers’ files held by the same hospitals. All members of their households were included, resulting in 77 case households (262 individuals) and 74 control households (230 individuals). Household exposure to SARS-CoV-2 during the first lockdown was categorized as high, intermediate or low, using a pre-established algorithm based on individual data on symptoms, high-risk contacts, activities outside the home and RT-PCR testing. Participants were offered a SARS-CoV-2 serological test.

Results
After adjustment for age, the association between chilblains and viral exposure was estimated at OR=3.3, 95%CI (1.4-7.3) for an intermediate household exposure, and 6.9 (2.5-19.5) for a high household exposure to SARS-CoV-2. Out of 57 case households tested, 6 (11%) had positive serology for SARS-CoV-2, whereas all control households tested (n=50) were seronegative (p=0.03). The effect of potential misclassification on exposure has been assessed in a bias analysis.

Conclusions
This case-control study demonstrates the association between chilblains occurring during the lockdown and household exposure to SARS-CoV-2.
Click to expand...

NewsBot · Oct 16, 2021

COVID Toes: Concurrent Lower Limb Arterial and Venous Thromboembolism in a Patient with COVID-19 Pneumonitis Presenting with Foot Ischaemia
Kathryn A Lee et al
Vasc Endovascular Surg. 2021 Sep 30

We present a 74-year-old gentleman, who presented with foot ischaemia requiring bilateral amputation in the absence of radiological signs of occlusive peripheral arterial disease. He was found to have COVID-19 pneumonitis and concurrent arterial and venous thromboemboli despite no initial respiratory symptoms or signs, nor pre-existing risk factors for cardiovascular disease. Patients who present with foot ischaemia with or without respiratory symptoms or signs warrant a high index of suspicion for COVID-19 infection, particularly in those with no predisposing risk factors.
Click to expand...

NewsBot · Oct 16, 2021

COVID-19 Associated Small Vessel Vasculitis

NewsBot · Oct 16, 2021

News Release 6-Oct-2021
Research reveals mechanisms behind “COVID toes”
Redness and swelling of the hands and toes, known as chilblain-like lesions, have been reported during the COVID-19 pandemic. A new study published in the British Journal of Dermatology uncovers the underlying mechanisms involved in such “COVID toes” symptoms.

The study included 50 participants with COVID toes and 13 with similar chilblains lesions that arose before the pandemic. The mechanisms behind both types involved an immune response with high levels of certain autoantibodies as well as type I interferon, a key protein in the antiviral response.

In addition to the immune system, endothelial cells that line blood vessels also appeared to play a critical role in the development of COVID toes and chilblains.

“The epidemiology and clinical features of chilblain-like lesions have been extensively studied and published, however, little is known about the pathophysiology involved,” said senior author Charles Cassius, MD, of Hôpital Saint-Louis, in Paris, France. “Our study provides new insights.”

NewsBot · Oct 16, 2021

COVID Toes and Seasonal Chilblains Share Similar Immune Responses

NewsBot · Oct 17, 2021

“COVID toes”: A meta-analysis of case and observational studies on clinical, histopathological, and laboratory findings
Kelvin Oliveira Rocha,Virgínia Vinha Zanuncio,Brunnella Alcântara Chagas de Freitas,Luciana Moreira Lima,
13 September 2021 https://doi.org/10.1111/pde.14805

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.
Click to expand...

NewsBot · Oct 17, 2021

Long-term Outcome of Chilblains Associated with SARS-CoV-2
Florence Poizeau et al
Acta Derm Venereol. 2021 Sep 13

Numerous cases of chilblains have been observed associated with the COVID-19 pandemic. The aims of this study were to provide comprehensive follow-up data for patients reporting chilblains, and to determine the risk factors for incomplete recovery. Patients referred to 5 hospitals in France between March and May 2020 for chilblains were surveyed on December 2020. A teleconsultation was offered. Among 82 patients reporting chilblains, 27 (33%) reported complete recovery, 33 (40%) had recurrences of chilblains after their hands and feet had returned to normal, and 22 (27%) developed persistent acral manifestations, mostly acrocyanosis, with or without further recurrences of chilblains. Most recurrences of chilblains occurred during the following autumn and winter. A past history of chilblains was not associated with recurrences or persistent acral manifestations. Women had a significantly higher risk of developing recurrences or persistent acral manifestations (odds ratio (OR) 1.30; 95% confidence interval (95% CI) 1.06-1.59). In conclusion, two-thirds of patients reporting chilblains at the start of the COVID-19 pandemic experienced persistent or recurrent acral manifestations after a 10-month follow-up.
Click to expand...

NewsBot · Jan 3, 2022

Chilblains and COVID-19—an Update on the Complexities of Interpreting Antibody Test Results, the Role of Interferon α, and COVID-19 Vaccines

NewsBot · Jan 8, 2022

Chilblain or Perniosis-like Skin Lesions in children during the COVID-19 pandemic: A Systematic Review of Articles.
Molaee H et al
Dermatologic Therapy, 03 Jan 2022, :e15298

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.
Click to expand...

NewsBot · Jan 8, 2022

Chronic Acral Lesions (“COVID Toes”): To Add to Long Post- COVID-19 Syndrome?

NewsBot · Feb 4, 2022

Not COVID Toes: Pool Palms and Feet in Pediatric Patients
Stephanie S Lee et al
Cutis. 2021 Nov;108(5):276-295

So-called COVID toes is probably the most publicized cutaneous manifestation of COVID-19. The parents of 4 patients pursued dermatology evaluation with concerns about COVID-19 infection in their children who presented with symmetric, focal, erythematous lesions of the hands or feet, or both. We elicited a history of extended time in swimming pools for the 4 patients that was associated with COVID-19 restrictions during summer months of the pandemic and recognized findings of frictional and pressure-induced erythema and scaling, leading to a diagnosis of pool palms and feet-an extension of pool palms. It is important to recognize this diagnosis and provide reassurance to the patients and caregivers because the condition warrants no notable workup or therapeutic intervention.
Click to expand...

NewsBot · Feb 12, 2022

Evolution of incidence of chilblain-like lesions in children during the first year of COVID-19 pandemic
Marta Bascuas-Arribas MD,David Andina-Martinez MD,Juan Añon-Hidalgo MD,Jose Antonio Alonso-Cadenas MD,Angela Hernandez-Martin MD,Nuria Lamagrande-Casanova MD …
07 February 2022

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.
Click to expand...

NewsBot · Mar 14, 2022

"COVID" Terminology in Dermatology
Vishal Gaurav, Chander Grover
Indian J Dermatol. Nov-Dec 2021;66(6):705

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.
Click to expand...

NewsBot · Mar 18, 2022

An illustrative case of pseudo-chilblains in tropical Singapore – what is its significance?

NewsBot · Mar 18, 2022

Lack of association between pandemic chilblains and
SARS-CoV-2 infection
Jeff R. Gehlhausen et al
PNAS 2022 Vol. 119 No. 9 e2122090119

An increased incidence of chilblains has been observed during the
severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
pandemic and attributed to viral infection. Direct evidence of this
relationship has been limited, however, as most cases do not have
molecular evidence of prior SARS-CoV-2 infection with PCR or antibodies. We enrolled a cohort of 23 patients who were diagnosed
and managed as having SARS-CoV-2–associated skin eruptions
(including 21 pandemic chilblains [PC]) during the first wave of the
pandemic in Connecticut. Antibody responses were determined
through endpoint titration enzyme-linked immunosorbent assay
and serum epitope repertoire analysis. T cell responses to SARSCoV-2 were assessed by T cell receptor sequencing and in vitro
SARS-CoV-2 antigen-specific peptide stimulation assays. Immunohistochemical and PCR studies of PC biopsies and tissue microarrays for evidence of SARS-CoV-2 were performed. Among patients
diagnosed and managed as “covid toes” during the pandemic, we
find a percentage of prior SARS-CoV-2 infection (9.5%) that
approximates background seroprevalence (8.5%) at the time.
Immunohistochemistry studies suggest that SARS-CoV-2 staining
in PC biopsies may not be from SARS-CoV-2. Our results do not
support SARS-CoV-2 as the causative agent of pandemic chilblains;
however, our study does not exclude the possibility of SARS-CoV2 seronegative abortive infections
Click to expand...

Significance
Chilblain diagnoses have increased during the severe acute
respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic
and have been attributed to viral infection and a subsequent
robust antiviral immune response. As a result, providers
have managed these cases differently than idiopathic chilblains, which are associated with cold exposure. The relationship between pandemic chilblains and SARS-CoV-2
infection, however, remains unclear as most patients do not
test positive for SARS-CoV-2–specific PCR or antibodies. To
better understand this disconnect, we enrolled cases of pandemic chilblains in a study and performed detailed immune
profiling of antibody and T cell responses. Additionally, we
compared immunohistochemical staining of pandemic chilblains with prepandemic tissues. Our results do not support
SARS-CoV-2 as the cause of the increased chilblain incidence.
Click to expand...

NewsBot · Mar 25, 2022

COVID toes following vaccination
Annia Cavazos et al
Baylor University Medical Center Proceedings: 15 Mar 2022

Cutaneous manifestations of COVID-19 infections include “COVID toes.” These are pernio-like, pale purple, painful, ill-defined cyanotic lesions that have inflammatory infiltrates on histologic studies. COVID toes can also develop following COVID vaccination. COVID toes was reported by 29 individuals to the Vaccine Adverse Event Reporting System maintained by the Centers for Disease Control and Prevention through May 25, 2021. The mean age of these individuals was 52 ± 18 years; 23 (79%) were women. They had received both mRNA vaccines and the adenovirus vector-based vaccine. This discoloration developed 4.5 ± 9.8 days following vaccination, usually after the first dose. Four individuals required hospitalization for systemic symptoms, and one died. This information indicates that some individuals develop important clinical syndromes following vaccination and suggests that some of the manifestations of COVID-19 infection represent immune responses and not necessarily active tissue infection.
Click to expand...

NewsBot · Mar 30, 2022

Acrocyanosis in a large italian pediatric series during the Covid-19 pandemic.
Soscia F et al
Minerva Pediatrics, 23 Mar 2022,

Background
SARS-CoV2 infection may present at onset with cutaneous manifestations as chilblains, pernio-like lesions characterized by rapid onset, itching, pain and tenderness and quick improvement with re-warming as similarly observed in primary acrocyanosis. The purpose of the present study was to detect in a single institution series of pediatric patients, during COVID-19 pandemic, the prevalence of acrocyanosis compared to previous period and an eventual correlation with SARS-Cov2 (Severe Acute Respiratory Syndrome Coronavirus 2) infection or other secondary etiologies of this disorder.
Methods
We retrospectively analyzed the prevalence of pediatric patients with acrocyanosis between January 2020 and July 2021, compared to the same period of previous year. All patients were investigated with capillaroscopies, clinical and laboratory texts. Those patients referred to our Institution, during the Covid-19 pandemic were also examined for SARS-CoV2 serologies to find out an eventual specific correlation with this secondary potential etiology.
Results
During the first wave of Covid-19 pandemic we observed an increased prevalence of this manifestation. The analysis showed that the higher prevalence of patients with acrocyanosis, in this period, was not related to SARS-Cov2 infection.
Conclusions
The acrocyanosis in pediatric patients is rarely associated with rheumatological diseases, being more frequently a primary disorder and strictly related to a sedentary lifestyle.
Click to expand...

NewsBot · Mar 30, 2022

Pandemic chilblains: Are they SARS-CoV-2-related or not?
AxelDe Greef et al
Clinical Immunology Volume 237, April 2022, 108984

Highlights
•The causal relationship between SARS-CoV-2 and pandemic chilblains is only tenuous.
•Most affected individuals have no detectable virus, no antibodies, no symptoms of COVID-19.
•Neither the viral genetic material nor the virus itself was detected in skin lesions.
•The causative role of a SARS-CoV-2-induced IFN-I response is not supported by many arguments.
•The importance of cold exposure related to unprecedented containment measures is possibly overlooked.
Click to expand...

The exact etiopathology of chilblains observed during the Coronavirus Disease 2019 (COVID-19) pandemic is still unclear. Initially, SARS-CoV-2 appeared as the obvious causing agent, but two years of various investigations have failed to convincingly support its direct implication. Most affected individuals have no detectable virus, no anti-SARS-CoV-2 antibodies and no symptoms of COVID-19. Analyses of skin biopsies similarly failed to unambiguously demonstrate presence of the virus or its genome. In a recent hypothesis, SARS-CoV-2 would cause the lesions before being promptly eliminated by unusually strong type I interferon responses. With others, we feel that environmental factors have not been sufficiently considered, in particular cold exposure related to unprecedented containment measures. The cause of pandemic chilblains remains a stimulating puzzle which warrants further investigation.
Click to expand...

NewsBot · Apr 4, 2022

Histopathology of Persistent Long COVID Toe: A Case Report
Michael S Nirenberg et al
J Cutan Pathol. 2022 Apr 2

During the 2020 coronavirus (SARS-CoV-2) pandemic, several cutaneous lesions were identified, including: pseudo-chilblain, vesicular, urticarial, maculopapular, and livedo/necrosis. A 59-year-old obese man with probable COVID-19 developed painful cyanosis with histopathologic capillary thrombosis of toes, and the cyanosis persisted for nearly 22 months. Shortly after initial exposure to family members with documented SARS-CoV-2, he developed upper respiratory symptoms, yet his anti-SARS-CoV-2 antibody and nasal swab RT-PCR tests were repeatedly negative. Two family members were hospitalized and one of them succumbed with documented SARS-CoV-2 pneumonia within ten days of exposure. Biopsy of the distal toe 16 weeks after initial exposure demonstrated papillary dermal capillary thrombosis with endothelial swelling, telangiectasia, and peri-eccrine lymphocytic infiltrates resembling pernio. Overall, this is the first case of biopsy of "long COVID toe" following presumed SARS-Cov-2 exposure, with demonstration of thrombotic vasculopathy, toe cyanosis, and pernio-like pathology.
Click to expand...

NewsBot · Apr 24, 2022

Isolated Presentation of COVID Toe in a 24-Year-Old Female with No Known Previous COVID-19 Infection
Kaajol Shah, Reshma Shah, DO
Source

Introduction: COVID toe is described as the outbreak of chilblains one to four weeks following infection with SARS-CoV-2. While it was initially seen in patients with severe disease, the rash is starting to be seen more frequently in younger patients with very mild disease or no known disease at all. In those cases, the rash is considered the first and only presentation of a COVID-19 infection. We present a patient in which that is the case.
Click to expand...

Craig Payne · Apr 24, 2022

NewsBot said: ↑

Isolated Presentation of COVID Toe in a 24-Year-Old Female with No Known Previous COVID-19 Infection
Click to expand...

Let me fix that:
"A 24-year old female got a chilblain"

NewsBot · Apr 26, 2022

Post SARS-CoV-2 Vaccine Chilblains-like Lesions
Rujittika Mungmunpuntipantip and Viroj Wiwanitkit
The Journal of Rheumatology April 2022

We would like to share ideas on the article, "A Case of Chilblains-like Lesions Post SARS-CoV-2 Vaccine?"1 Meara et al reported a female case and concluded, "The chilblains-like lesions suggest that she had an antibody response from either 1 vaccine dose or a previous PCR-negative COVID-19 [coronavirus disease 2019] infection."1
Click to expand...

NewsBot · Apr 27, 2022

Snotwatch COVID-Toes: An ecological study of chilblains and COVID-19 diagnoses in Victoria, Australia
Rana Sawires, et al
Source

Background The COVID-19 pandemic has caused widespread illness with varying clinical manifestations. One less-commonly-reported presentation of COVID-19 infection is chilblain-like lesions.

Aims We conducted an ecological analysis of chilblain presentations in comparison with confirmed and suspected COVID-19 infections in a primary care setting to establish that a relationship exists between the two.

Study Design Our study collated data from three Primary Health Networks across Victoria, Australia, from 2017-2021, to understand patterns of chilblain presentations prior to and throughout the pandemic. Using a zero-inflated negative binomial regression analysis, we estimated the relationship between local minimum temperature, COVID-19 infections and the frequency of chilblain presentations.

Results We found a 5.72 risk ratio of chilblain incidence in relation to COVID-19 infections and a 3.23 risk ratio associated with suspected COVID-19 infections. COVID-19 infections were also more strongly associated with chilblain presentations in 0-16-year-olds throughout the pandemic in Victoria.

Conclusion Our study statistically demonstrates that chilblains are significantly associated with COVID-19 infections in a primary care setting. This has major implications for clinicians aiming to diagnose COVID-19 infections or determine the cause of a presentation of chilblains. Additionally, we demonstrate the utility of large-scale primary care data and its potential application to monitoring the spread of COVID-19 infections across the state, supporting current epidemiological efforts for COVID-19 tracking.
Click to expand...

NewsBot · May 3, 2022

Vaccine Toes Are the New COVID Toes
Hodge B et al
Skin Appendage Disord

Introduction: Pernio-like lesions were reported as dermatologic manifestations of COVID-19 as early as May of 2020. Since mRNA COVID-19 vaccines were introduced in December 2020, 9 reports of vaccine-associated pernio-like lesions have been presented in the medical literature. Case Presentation: A male in his 60s developed pernio-like lesions on the bilateral toes approximately 1 week after receiving the second dose of the Pfizer-BioNTech COVID-19 mRNA vaccine. His symptoms resolved in 6 weeks. Conclusion: The rising number of reports of pernio-like lesions associated with COVID-19 vaccination underlines the importance of the pathophysiological state of the vaccinated patient and how it relates to dermatological manifestations. Pernio-like lesions are thought to represent a robust host immune antiviral response related to production of interferon-1 in the setting of primary infection; incidences occurring after vaccination further support this theory. Unfortunately, media-generated reports of such reactions have the potential to inflame distrust and fear of the vaccine among the general public. Given the previous media interest in reporting pernio-like lesions with primary COVID-19 infection, it is reasonable to expect overrepresentation of pernio-like lesions with vaccination. There appears to be a general increase in patient distrust of evidence-based medicine and thus “COVID toes” represent an important intersection at which the clinician can capture the patient’s trust by providing education and counseling.
Click to expand...

NewsBot · May 3, 2022

Paediatric COVID toes and the recommended care management
Christina Leung, Lisa Brent
ABSTRACTS FROM THE NEONATAL AND PAEDIATRIC PHARMACISTS CONFERENCE 2021

Aim To define COVID toes and fingers in paediatrics, and to explain the aetiology, the assessment and investigation management, the diagnosis, the clinical presentation and the care management including the use of oral nifedipine in this newly found disease during the COVID-19 pandemic. In addition, we will illustrate the process using the multi-disciplinary approach to prepare the Paediatric COVID toes guideline in our Trust, and to cite some examples of the related patient cases seen in our hospital as well as to summarise the total number of patient cases seen to date.

Method To carry out a literature search to find out the latest related articles and clinical studies, and to summarise the findings to prepare for the drafting of the clinical guideline. This guideline was initially prepared by the medical team and was then reviewed using multi-disciplinary team (MDT) approach including the paediatric pharmacists and the consultation from the tertiary paediatric centre. We also summarised the number of paediatric patient cases that were seen in our Trust and categorised them into different age groups, ethics background, and referral systems.

Results A number of related articles were found after the literature search. The first draft of the Paediatric COVID-toes guideline was prepared in March 2021 and it was then reviewed by the MDT in the Paediatric Clinical Guideline Group of our Trust. The paediatric pharmacist expressed her comments including the drug of choice such as oral nifedipine, the dosages below and above 2 years of age, the evidence to support the dosage recommendations, the different formulations available in the market for oral nifedipine such as oral suspension, capsule, tablet and modified-released (MR) tablet, recommended effective method for oral administration, side effects profile, monitoring such as blood pressure, patient counselling and education, and provision of patient leaflet and video-link to aid patient compliance.

Conclusion The final version of the Paediatric COVID toes guideline was prepared by the multi-disciplinary team in July, 2021, and it was uploaded in the Trust intranet in August 2021. In view of the literature search, there is limited evidence to support the use of oral nifedipine under 2 years of age for this indication. In our guideline, we recommend the dose of nifedipine to be 2.5–10 mg 2–4 times a day for children age 2 to 17 years old, starting with low doses at night and increase gradually by closely monitoring blood pressure and other side effects. The use of oral nifedipine is unlicensed for this indication in children. In our guideline, we recommend the use of oral MR nifedipine tablet after the consultation with the tertiary centre. Oral suspension is not routinely used. During counselling session, the pharmacist will advise the parent/carer to crush and dissolve the MR tablet in water and give appropriate dose accordingly. To date, 15 patients diagnosed with this disease were seen in our clinic. They are mainly referred to the clinic via the Accident and Emergency Department. The patient ages are all above 8 years old and they are mainly of Asian ethical background.
Click to expand...

NewsBot · May 4, 2022

COVID toe in an adolescent boy: a case report

NewsBot · May 30, 2022

PSEUDOPERNIOSIS AS A LATE MANIFESTATION AFTER SARS2-COD19 INFECTION. A PURPOSE OF A SERIES OF 19 CASES
F. J. Navarro Blasco1
Annals of the Rheumatic Diseases 2022;81:1670.

Background In winter, you can usually see a picture of Perniosis and / or chilblains. Painful, often itchy, red-to-purple lesions that affect the acrid surfaces of the fingers and toes after contact with the cold, resembling vasculitis, characterize them. Chilblains can be idiopathic and self-limiting or associated with systemic diseases. The diagnosis is usually clinical, but in some circumstances, analytical and microscopic studies of a biopsy sample may be necessary. We present a series of 19 consecutive cases of Pseudoperniosis associated with probable past INFECTION by SARS-CoV-2.

Methods During the winter 2020-21, an unexpected number of cases referred as “acute arthritis/vasculitis” have been received in our rheumatology section and associated consultations. In the pathochrony of patients, exposure to cold was referred to as the main triggering factor. Initially qualified as PERNIOSIS. Given the appearance in the current situation of Pandemic by covid-19, we began to request the serology SARS2-COVID19 IgG / IgM. Appreciating an approximate rate of 70% of IgG+ positivity in which it was performed.

Results Characteristics of the clinical data collected evolutionarily in the 19 patients: These are preferably young people, without any other pathology, although there are also people of all ages, with a clinical picture of edema of soft parts preferably of the hands, but also in the feet, with pain and some hemorrhage infusions, including ulcerations in the areas of the knuckles or pressure (PHOTO1-2-3). Despite the overwhelming nature of the picture, they do not associate any other symptoms and the analyses are normal, including acute phase reactants (ESR and PCR), and serological markers of autoimmune disease. Approximately 1/4 of them reported having passed clinical compatible with the covid19 infection and / or having been isolated with some minor symptom, but they had not been performed PCR. The others did not report any symptoms associated with COD19 infection. From the initial diagnosis, about 40 days passed on average. Many of them were being treated with corticosteroids/NSAIDs without improvement. In the ultrasounds performed, only edema of periarticular and paratendinous tissue is appreciated, such as that which can occur after a momentary ischemic picture. All evolved favorably avoiding cold (probable triggering factor), and with antiplatelet agent (infant aspirin).

Conclusion This picture of Pseudoperniosis lacks the typical pruritus of perniosis and the main problem is pain along with edema of the tissues of the hand that leads to make it impossible to use. Similarly, asymmetric lesions similar to perniosis were observed in patients who presented skin manifestations of SARS-CoV-2 infection in a study conducted in Spain (1). We are following these patients to assess if there is any relationship with any other factor that facilitates this unusual incidence, and at the same time indicate the transience of the clinical picture that evolves favorably in a few weeks.
Click to expand...

NewsBot · May 31, 2022

Pernio not “COVID-19 Toes”

NewsBot · Jun 26, 2022

“COVID Toes”: A True Viral Phenomenon or a Diagnosis Without a Leg to Stand on?
Jia C.GaoBS et al
JAAD International; 19 June 2022

“COVID toes” is the colloquial name of chilblain-like lesions (CBLL) thought to be a sequela of COVID-19 infection. Over two years and roughly 300 publications later, this association remains controversial. Here we summarize key clinical, serological, biological, histological and immunological evidence that supports and rejects this relationship as well as discuss alternate theories underlying CBLL pathogenesis
Click to expand...

NewsBot · Jun 27, 2022

A curious case of ‘COVID toes’ in pregnancy
Harold Wilson-Morkeh, Iona Thorne
Obstetric Medicine June 19, 2022

The novel coronavirus of 2019 (COVID-19) can affect multiple organ systems with a wide spectrum of illness severity. Its effect on the respiratory tract is well-documented and has resulted in considerable excess mortality worldwide. However, observed cutaneous manifestations of COVID-19 are rising, ranging from short-lived viral exanthems to vesicular eruptions and urticaria. An unusual subgroup of these manifestations – pseudo-chilblains, also referred to as pernio-like lesions or ‘COVID toes’ – describes the acral areas of erythema and oedema that can affect young individuals following COVID-19. We present a case associated with pustule and vesicle formation occurring in the context of pregnancy.
Click to expand...

NewsBot · Jun 29, 2022

Post-SARS-CoV-2 vaccination COVID toes and fingers
Two case reports and a short literature review
Uwe Wollina
Wiener Medizinische Wochenschrift (2022)

We have observed two patients who developed painful pernio-like plaques on fingers and/or toes after vaccination against severe acute respiratory corona virus type 2 (SARS-CoV‑2), resembling corona virus disease (COVID) toes or fingers.
Click to expand...

NewsBot · Jun 29, 2022

Chilblain-like lesions onset during SARS-CoV-2
infection in a COVID-19-vaccinated adolescent:
Case report and review of literature
Roberto Paparella et al
Research Square

Background: COVID toes or chilblain-like skin lesions have been widely reported during COVID-19
pandemic. Most cases were described in patients with negative microbiological tests for SARS-CoV-2,
therefore the possible relationship with SARS-CoV-2 infection, as well as with the nowadays broadly
available mRNA-based vaccination, has not been fully elucidated.
Case presentation: We here describe the case of a 14-year-old male who developed chilblain-like skin
eruptions during SARS-CoV-2 infection despite two mRNA-based vaccine doses and review the clinical
and epidemiological characteristics of chilblain-like lesions as a cutaneous presentation of COVID-19 in
children.
Conclusions: Most children and adolescent with COVID toes have a mild or asymptomatic SARS-CoV-2
infection. Our report aims to highlight the possible onset of these skin lesions in vaccinated children, if
infection has occurred, and the potential use of systemic corticosteroids as a first line treatment.
Additional evidence is required to better understand SARS-CoV-2 infection and cutaneous manifestations
in children and determine the relationship between chilblain-like lesions and COVID-19 vaccination.
Click to expand...

NewsBot · Jul 12, 2022

COVID-19 pandemic - related chilblains: clinical and immunological characterization of an Italian cohort
Signa, S.; Manunza, F.; Pastorino, C.; Bocca, P.; Corcione, A.; Penco, F.; Bertoni, A.; Airoldi, I.; Viglizzo, G.; Morandi, F.; Rosina, S.; Viola, S.; Occella, C.; Acquila, M.; Podest, M.; Ravelli, A.; Castagnola, E.; Gattorno, M.; Volpi, S..
Pediatric Rheumatology ; 20(SUPPL 1), 2022.

Introduction:
During COVID-19 pandemic, acute acral chilblain-like lesions (ACBLL), reminiscent of lupus pernio, were observed during both first and second COVID-19 peak among patients with highly suspected (but mostly unconfirmed) infection with SARS-CoV-2.The aetiology of this phenomenon has not been elucidated yet and pathogenetic mechanism remains unknown. Several studies have investigated cytokine and chemokine profile in patients with COVID-19 but an accurate characterization of ACBLL patients is lacking.
Objectives:
We aimed to describe the clinical, laboratory and immunological features of children presenting with ACBLL referred to our Institute during the COVID-19 pandemic spread.
Methods:
We prospectively collected data of children referred to our Institute from April 1st 2020 to February 28th 2021. We investigate the presence of SARS-CoV2 infection through RT-PCR from nasopharingeal swabs and three different serologic kit. All patients underwent a laboratory work-up including coagulation, viral serology and autoantibodies panel. Finally, we analysed peripheral blood IFN signature, a panel of inflammatory biomarkers in serum/plasma by a flow cytometry bead array (CXCL10, CXCL9, IL-6, IL-1β,TNFα) and the presence of SARS-CoV2 T specific lymphocytes.
Results:
We examined 36 children during the first peak, and 11 children during the second COVID-19 peak (F 28 median age 12 y), at a median delay of 26 days after symptoms onset (2-73 days). Fifteen patients (31%) presented non-specific systemic symptoms preceding ACBLL onset. Nine patients (19%) reported a possible contagion from a close contact. All patients presented stereotypical features resembling classical chilblains with acral erythematousedematous violaceous plaques and nodules localized on the toes (n= 35, 74%), the fingers (n=5, 10%) or on both sites (n=7, 15%). SARSCoV- 2 RNA detection resulted negative except for 2 patients. Furthermore, ten patients observed during the first wave showed a recurrence during the second (F6), which developed 1-4 weeks after the second COVID-19 peak the clinical features were comparable to those of the previous episode. Five of them (50%) reported nonspecific systemic symptoms before onset and/or close contact with SARS-CoV2 positive subject. Repeated SARS-CoV-2 specific IgG/IgA tests were negative for all patients except for three cases (two of them with positive swabs). Neither common virus serology nor coagulation studies revealed significative results. Two patients presented positive ANA and anti β2 glycoprotein, respectively. A positive IFN signature was detected in 12/ 33 patients (36%).Among the 35 patients tested, the cytokine array showed high levels of IP10 (n= 35, range 12.4-739 pg/ml, n.v. 0.0-0.2 pg/ml) and a mild increase of IL-6 (n=21, range 2.4-401 pg/ml, n.v. 0.5-2.2pg/ml), without alterations of CXCL9, IL-1β and TNFa. The detection of SARS-CoV2 specific lymphocytes showed the presence of SARS-CoV2 specific lymphocytes in 9/17 (52%) patients tested (validated with positive and negative controls), only one of them with a positive serological test.
Conclusion:
Albeit the pathogenetic mechanism of ACBLL remains to be elucidated, our preliminary results showed a significant increase in serum IP10 levels, not frankly associated with a peripheral blood IFN signature, which is instead a characteristic of pernio-related chilblains. We also proved the presence of a T-specific memory against in 50% of the tested patients, despite the negativity of coltures and serological tests, strengthening the link between SARS-CoV2 infection and this peculiar clinical manifestation.
Click to expand...

NewsBot · Jul 13, 2022

Acral Changes in pediatric patients during COVID 19 pandemic: Registry report from the COVID 19 response task force of the society of pediatric dermatology (SPD) and pediatric dermatology research alliance (PeDRA)
Leslie Castelo-Soccio MD, PhD,Irene Lara-Corrales MD,Amy S. Paller MD,Eric Bean BS,Sneha Rangu BS,Michelle Oboite MD,Carsten Flohr MD,Regina-Celeste Ahmad MD, PhD
20 March 2021

Background/Objective
In spring 2020, high numbers of children presented with acral pernio-like skin rashes, concurrent with the coronavirus disease 2019 (COVID-19) pandemic. Understanding their clinical characteristics/ infection status may provide prognostic information and facilitate decisions about management.

Methods
A pediatric-specific dermatology registry was created by the Pediatric Dermatology COVID-19 Response Task Force of the Society for Pediatric Dermatology (SPD) and Pediatric Dermatology Research Alliance (PeDRA) and was managed by Children's Hospital of Philadelphia using REDCap.

Results
Data from 378 children 0-18 years entered into the registry between April 13 and July 17, 2020 were analyzed. Data were drawn from a standardized questionnaire completed by clinicians which asked for demographics, description of acral lesions, symptoms before and after acral changes, COVID-19 positive contacts, treatment, duration of skin changes, laboratory testing including SARS-CoV-2 PCR and antibody testing, as well as histopathology. 229 (60.6%) were male with mean age of 13.0 years (± 3.6 years). Six (1.6%) tested positive for SARS-CoV-2. Pedal lesions (often with pruritus and/or pain) were present in 96%. 30% (114/378) had COVID-19 symptoms during the 30 days prior to presentation. Most (69%) had no other symptoms and an uneventful course with complete recovery.

Conclusions and Relevance
Children with acral pernio-like changes were healthy and all recovered with no short-term sequelae. We believe these acral changes are not just a temporal epiphenomenon of shelter in place during the spring months of the first wave of the COVID-19 pandemic and may be a late phase reaction that needs further study.
Click to expand...

NewsBot · Jul 25, 2022

Pandemic associated chilblain-like lesions result from an inducible type 1 interferon response to SARS-CoV-2
L. Arkin et al
J Invest Dermatol. 2022 Aug; 142(8): B25.

Chilblain-like lesions (CLL), known in the lay press as “COVID toes,” increased significantly during the COVID-19 pandemic. The phenotypic similarity of chilblains in the monogenic type 1 interferonopathies, coupled with the consistent clinical phenotype across multiple countries and temporospatial association with COVID-19 spread, suggest a SARS-CoV-2 triggered immune phenomenon. Yet direct evidence of this relationship has been limited due to low rates of SARS-CoV-2 positivity utilizing conventional testing. We prospectively enrolled a cohort of 79 patients with CLL across 4 waves of the SARS-CoV-2 pandemic in Wisconsin collecting serial blood samples and lesional skin biopsies. Immunophenotyping including the type 1 interferon (IFN-1) signature was investigated utilizing multiplex immunohistochemistry in affected tissue. Proteomics and RNA sequencing were performed on the peripheral blood at serial time points. RNAscope for S gene and depositional immunohistochemistry for evidence of SARS-CoV-2 were performed on tissue. Antibody responses and T-cell specific responses to SARS-CoV-2 were performed and an animal model (golden hamster) provided mechanistic evidence of dissemination of viral RNA to acral sites with local IFN-1 activation. Our results support an inducible local and peripheral IFN-1 signature, which abrogates within weeks, with evidence of viral SARS-CoV-2 RNA as the trigger.
Click to expand...

NewsBot · Aug 9, 2022

Chilblains After SARS-CoV-2 Vaccination: Coincidence or Real Association?
Anastasios Karamanakos, Gerasimos Evangelatos, Maria Pappa, Kalliopi Fragiadaki, Antonis Fanouriakis and George E. Fragoulis
The Journal of Rheumatology August 2022

We read with great interest the article of Meara et al1 in your journal describing a case of chilblain-like lesions after vaccination against SARS-CoV-2. Since the start of the coronavirus disease 2019 (COVID-19) pandemic, millions of vaccine doses have been administered and their safety has been generally confirmed.
Click to expand...

Chilblains and Covid-19 (Covid Toes)

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

Craig Payne Moderator

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

Chilblains or covid toes?

Chilblains and Leukaemia

Chilblains

Chilblains are the pain of my life right now

Nifedipine Vs Placebo For Treatment Of Chilblains

Topical glyceryl trinitrate vs. oral nifedipine for chilblains

Chilblains in Children

Share This Page

Useful Searches