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Poizeau F, Barbarot S, Le Corre Y, Brenaut E, Samimi M, Aubert H, Toubel A, Dupuy A. Long-term Outcome of Chilblains Associated with SARS-CoV-2. Acta Derm Venereol 2021; 101:adv00614. [PMID: 34515805 PMCID: PMC9472087 DOI: 10.2340/00015555-3930] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Numerous cases of chilblains have been observed in the course if 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 1.30; 95% confidence interval 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.
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Affiliation(s)
- Florence Poizeau
- EA 7449 REPERES (Pharmacoepidemiology and Health Services Research), Rennes 1 University, Rennes, France
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Kolivras A, Thompson C, Pastushenko I, Mathieu M, Bruderer P, de Vicq M, Feoli F, Harag S, Meiers I, Olemans C, Sass U, Dehavay F, Fakih A, Lam-Hoai XL, Marneffe A, Van De Borne L, Vandersleyen V, Richert B. A clinicopathological description of COVID-19-induced chilblains (COVID-toes) correlated with a published literature review. J Cutan Pathol 2021; 49:17-28. [PMID: 34272741 PMCID: PMC8444728 DOI: 10.1111/cup.14099] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 06/14/2021] [Accepted: 07/12/2021] [Indexed: 12/17/2022]
Abstract
Background The abundance of publications of COVID‐19‐induced chilblains has resulted in a confusing situation. Methods This is a prospective single‐institution study from 15 March to 13 May 2020. Thirty‐two patients received PCR nasopharyngeal swabs. Of these, 28 patients had a thoracic CT‐scan, 31 patients had blood and urine examinations, 24 patients had skin biopsies including immunohistochemical and direct immunofluorescence studies, and four patients had electron microscopy. Results COVID‐19‐induced chilblains are clinically and histopathologically identical to chilblains from other causes. Although intravascular thrombi are sometimes observed, no patient had a systemic coagulopathy or severe clinical course. The exhaustive clinical, radiological, and laboratory work‐up in this study ruled‐out other primary and secondary causes. Electron microscopy revealed rare, probable viral particles whose core and spikes measured from 120 to 133 nm within endothelium and eccrine glands in two cases. Conclusion This study provides further clinicopathologic evidence of COVID‐19‐related chilblains. Negative PCR and antibody tests do not rule‐out infection. Chilblains represent a good prognosis, occurring later in the disease course. No systemic coagulopathy was identified in any patient. Patients presenting with acral lesions should be isolated, and chilblains should be distinguished from thrombotic lesions (livedo racemosa, retiform purpura, or ischemic acral necrosis).
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Affiliation(s)
- Athanassios Kolivras
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium.,Department of Dermatopathology, Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Curtis Thompson
- Departments of Dermatology and Pathology, Oregon Health and Science University, Portland, Oregon, USA.,CTA Pathology, Portland, Oregon, USA
| | - Ievgenia Pastushenko
- Laboratory of Stem Cells and Cancer, Université Libre de Bruxelles, Brussels, Belgium
| | - Marisa Mathieu
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Pascal Bruderer
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium.,Department of Dermatopathology, Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Marine de Vicq
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium.,Department of Dermatopathology, Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Francesco Feoli
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium.,Department of Dermatopathology, Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Saadia Harag
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium.,Department of Dermatopathology, Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Isabelle Meiers
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium.,Department of Dermatopathology, Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Catherine Olemans
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium.,Department of Dermatopathology, Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Ursula Sass
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium.,Department of Dermatopathology, Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Florence Dehavay
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Ali Fakih
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Xuan-Lan Lam-Hoai
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Alice Marneffe
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Laura Van De Borne
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Valerie Vandersleyen
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium.,Department of Dermatopathology, Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Bertrand Richert
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium
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