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Chilblain-like lesions coinciding with the SARS-CoV-2 pandemic.

ABSTRACT: Chilblain-like lesions (CLL) coinciding with SARS-CoV-2 infection have been described. Previous systematic reviews suggest CLL are associated with younger age, an equal sex ratio, negative testing for SARS-CoV-2, and mild to no extracutaneous symptoms. A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines on CLL coinciding with SARS-CoV-2 to clarify the demographic characteristics, clinical features, and resolution outcomes of these skin findings. One hundred twenty-eight studies, published between March 2020 and January 2022, met inclusion criteria and were summarized in this review, representing 4,982 cases of CLL. Available data showed a slight female predominance (55%, n = 2,471 of 4,472). The mean age was 25 years, ranging from 0 to 95 years. Most cases were not associated with extracutaneous signs and symptoms (63%, n = 1,649 of 2,636). Overall, 19% (n = 347 of 1,838) of patients tested positive for SARS-CoV-2 using polymerase chain reaction, serology, or tissue biopsy. Clinical course was generally benign with 80% (n = 979 of 1,224) of cases resolving and 47% (n = 204 of 432) resolving without receiving treatment. This review provides a comprehensive summary of CLL associated with SARS-CoV-2. CLL occurred at a mean age of 25 years with a slight female predominance. The majority had negative COVID-19 testing, no extracutaneous signs and symptoms, and resolution without recurrence.

SUBMITTER: Starkey SY

PROVIDER: S-EPMC9551125 | biostudies-literature | 2022 Oct

REPOSITORIES: biostudies-literature

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Chilblain-like lesions coinciding with the SARS-CoV-2 pandemic.

Starkey Samantha Y SY Mar Kristie K Kashetsky Nadia N Lam Joseph M JM Dutz Jan J Mukovozov Ilya I

Clinics in dermatology 20221011 1

Chilblain-like lesions (CLL) coinciding with SARS-CoV-2 infection have been described. Previous systematic reviews suggest CLL are associated with younger age, an equal sex ratio, negative testing for SARS-CoV-2, and mild to no extracutaneous symptoms. A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines on CLL coinciding with SARS-CoV-2 to clarify the demographic characteristics, clinical features, and resolution o ...[more]

PMID: 36228990

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Project description:ImportanceChilblain-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.ObjectiveTo examine the association of chilblain-like lesions with SARS-CoV-2 infection.Design, setting, and participantsThis 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 measuresMacroscopic (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.ResultsOf 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 relevanceThis 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.

Project description:ImportanceChilblain-like lesions have been reported during the coronavirus 2019 (COVID-19) pandemic. The pathophysiology of such manifestations remains largely unknown.ObjectiveTo perform a systematic clinical, histologic, and biologic assessment in a cohort of patients with chilblain-like lesions occurring during the COVID-19 pandemic.Design, setting, and participantsIn this prospective case series carried out with a COVID-19 multidisciplinary consultation group at the University Hospital of Nice, France, 40 consecutive patients presenting with chilblain-like lesions were included.Main outcomes and measuresPatients underwent a thorough general and dermatologic examination, including skin biopsies, vascular investigations, biologic analyses, interferon-alpha (IFN-α) stimulation and detection, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) and serologic analysis.ResultsOverall, 40 consecutive patients with chilblain-like lesions were included. Most patients were young, with a median (range) age of 22 (12-67) years; 19 were male and 21 were female. The clinical presentation was highly reproducible with chilblain-like lesions mostly on the toes. Bullous and necrotic evolution was observed in 11 patients. Acrocyanosis or cold toes were reported in 19 (47.5%) cases. Criteria compatible with COVID-19 cases were noted in 11 (27.5%) within 6 weeks prior to the eruption. The real-time PCR (rt-PCR) testing results were negative in all cases. Overall, SARS-CoV-2 serology results were positive in 12 patients (30%). D-dimer concentration levels were elevated in 24 (60.0%) cases. Cryoglobulinemia and parvovirus B19 serologic results were negative for all tested patients. The major histologic findings were features of lymphocytic inflammation and vascular damage with thickening of venule walls and pericyte hyperplasia. A significant increase of IFN-α production after in vitro stimulation was observed in the chilblain population compared with patients with mild-severe acute COVID-19.Conclusions and relevanceTaken together, our results suggest that chilblain-like lesions observed during the COVID-19 pandemic represent manifestations of a viral-induced type I interferonopathy.Trial registrationClinicalTrials.gov Identifier: NCT04344119.

Project description:Prior studies suggest that population heterogeneity in SARS-CoV-2 (COVID-19) transmission plays an important role in epidemic dynamics. During the fall of 2020, many US universities and the surrounding communities experienced an increase in reported incidence of SARS-CoV-2 infections, with a high disease burden among students. We explore the transmission dynamics of an outbreak of SARS-CoV-2 among university students, how it impacted the non-student population via cross-transmission, and how it could influence pandemic planning and response. Using surveillance data of reported SARS-CoV-2 cases, we developed a two-population SEIR model to estimate transmission parameters and evaluate how these subpopulations interacted during the 2020 Fall semester. We estimated the transmission rate among the university students (βU) and community residents (βC), as well as the rate of cross-transmission between the two subpopulations (βM) using particle Markov Chain Monte Carlo (pMCMC) simulation-based methods. We found that both populations were more likely to interact with others in their population and that cross-transmission was minimal. The cross-transmission estimate (βM) was considerably smaller [0.04 × 10-5 (95% CI: 0.00 × 10-5, 0.15 × 10-5)] compared to the community estimate (βC) at 2.09 × 10-5 (95% CI: 1.12 × 10-5, 2.90 × 10-5) and university estimate (βU) at 27.92 × 10-5 (95% CI: 19.97 × 10-5, 39.15 × 10-5). The higher within population transmission rates among the university and the community (698 and 52 times higher, respectively) when compared to the cross-transmission rate, suggests that these two populations did not transmit between each other heavily, despite their geographic overlap. During the first wave of the pandemic, two distinct epidemics occurred among two subpopulations within a relatively small US county population where university students accounted for roughly 41% of the total population. Transmission parameter estimates varied substantially with minimal or no cross-transmission between the subpopulations. Assumptions that county-level and other small populations are well-mixed during a respiratory viral pandemic should be reconsidered. More granular models reflecting overlapping subpopulations may assist with better-targeted interventions for local public health and healthcare facilities.

Dataset Information

Chilblain-like lesions coinciding with the SARS-CoV-2 pandemic.

Publications

Chilblain-like lesions coinciding with the SARS-CoV-2 pandemic.

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