Pediatric COVID toes and fingers

Area of Science:

• Pediatric Dermatology
• Infectious Diseases
• Immunology

Background:

• The COVID-19 pandemic has presented with diverse clinical manifestations, including unusual dermatologic findings in children.
• COVID toes, characterized by inflammatory nodules on the feet and hands, mimic chilblains (acral pernio).
• Children with these lesions often have asymptomatic or mild coronavirus disease 2019 (COVID-19).

Purpose of the Study:

• To explore the association between chilblain-like lesions in children and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
• To understand the immunological implications and prognosis of these dermatologic manifestations.

Main Methods:

• Review of clinical presentations of pediatric patients with chilblain-like lesions during the pandemic.
• Analysis of serological studies investigating SARS-CoV-2 antibodies (IgA, IgG) in affected children.
• Consideration of environmental factors, such as cold weather and barefoot exposure.

Main Results:

• COVID toes present as inflammatory nodules, primarily on toes and feet, sometimes affecting hands.
• While some studies suggest a link to SARS-CoV-2 via antibodies, others indicate no definitive association, pointing to environmental factors.
• Children with these lesions typically exhibit mild or no symptomatic COVID-19.

Conclusions:

• Chilblain-like lesions during the COVID-19 pandemic in children may represent a robust immune response, potentially indicating innate immunity and a favorable prognosis.
• The exact link between SARS-CoV-2 and these lesions requires further investigation.
• The role of coagulopathy screening remains uncertain but warrants consideration.