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Evaluation of Chilblains as a Manifestation of the COVID-19 Pandemic
Anne Herman1,2, Caroline Peeters1, Alexia Verroken3
1Department of Dermatology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
Insights
Chilblains were not directly linked to COVID-19 in a study of 31 patients. Researchers suggest lifestyle changes during lockdown may explain these skin lesions.
Area of Science:
- Dermatology
- Infectious Diseases
- Public Health
Background:
- The coronavirus disease 2019 (COVID-19) pandemic has seen reports of chilblain-like lesions.
- The potential association between chilblains and COVID-19 requires investigation.
Purpose of the Study:
- To determine if chilblains are associated with COVID-19 infection.
- To investigate the clinical and laboratory findings in patients presenting with chilblains during the pandemic.
Main Methods:
- A monocentric case series of 31 patients with recent-onset chilblains was conducted.
- Patients underwent nasopharyngeal swabs and skin biopsy for SARS-CoV-2 RNA detection (RT-PCR).
- Blood samples were tested for SARS-CoV-2 IgM and IgG antibodies, and extensive blood analyses were performed.
Main Results:
- No patients tested positive for SARS-CoV-2 RNA in nasopharyngeal swabs or skin biopsies.
- All patients had negative IgM and IgG antibody titers for SARS-CoV-2.
- Histopathology confirmed chilblains, with some showing lymphocytic or microthrombotic phenomena; immunofluorescence revealed vasculitis in some cases.
Conclusions:
- Chilblains in this cohort did not appear to be directly associated with COVID-19.
- Lifestyle modifications due to community containment and lockdown measures are a plausible cause for these lesions.
Importance:
During the coronavirus disease 2019 (COVID-19) pandemic, several cases of chilblains have been reported.
Objective:
To determine if chilblains are associated with COVID-19.
Design, Setting, And Participants:
This monocentric case series was conducted at the Department of Dermatology at Cliniques universitaires Saint-Luc, a tertiary care hospital in Brussels, Belgium, between April 10 and April 17, 2020. We evaluated a total of 31 referred patients who had recently developed chilblains.
Main Outcomes And Measures:
Real-time reverse transcriptase-polymerase chain reaction (RT-PCR) was used to detect severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA on nasopharyngeal swabs for all patients and in skin biopsy specimens for 22 patients. Blood samples from all patients were tested for specific anti-SARS-CoV-2 immunoglobulin (Ig) M and IgG antibodies. All patients had extended blood analyses. Histologic (22 patients) and immunofluorescence examinations (15 patients) were performed on the skin biopsy specimens.
Results:
The 31 patients were generally in good health; most were teenagers or young adults, and 19 were women. Histopathologic analysis of skin biopsy specimens (22 patients) confirmed the diagnosis of chilblains and showed occasional lymphocytic or microthrombotic phenomena. Immunofluorescence analyses showed vasculitis of small-diameter vessels in 7 patients. In all patients, SARS-CoV-2 RNA remained undetected by RT-PCR on nasopharyngeal swabs and in biopsy samples of the skin lesions. The IgM and IgG antibody titers were negative for SARS-CoV-2 in all patients (<1.0 arbitrary unit/mL). No significant abnormalities in blood test results were suggestive of systemic disease. Antinuclear antibody titers were low in 7 patients and higher in 1 patient.
Conclusions And Relevance:
Chilblains appeared not to be directly associated with COVID-19 in this case series. Lifestyle changes associated with community containment and lockdown measures are a possible explanation for these lesions.
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