1
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Ică OM, Mitroi G, Ianoşi SL, Tutunaru CV, Leru PM, Matei D, Avramescu ET, Tănasie CA, Mitroi IB, Neagoe CD, Cazacu SM. Defining the short-term and long-term skin manifestations of COVID-19: insights after more than three years of the pandemic. Rom J Morphol Embryol 2023; 64:291-304. [PMID: 37867347 PMCID: PMC10720941 DOI: 10.47162/rjme.64.3.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/22/2023] [Indexed: 10/24/2023]
Abstract
AIM This review aimed to assess the impact of coronavirus disease 2019 (COVID-19) on skin health to establish a classification of the skin lesions that occur most frequently during the disease and whether a particular category of skin damage is more likely to occur both in the short term and in the long term. METHODS We conducted a literature search of the PubMed database. Ultimately, 109 articles were included in this review. The exact phrases∕syntax and connectors used for the database search∕query were as follows: "Coronavirus and skin", "COVID-19 and skin", "SARS-CoV-2 and skin", "Coronavirus cutaneous manifestations", "COVID-19 cutaneous manifestations", "SARS-CoV-2 cutaneous manifestations", "Coronavirus dermatology", "SARS-CoV-2 and dermatology", "COVID-19 and dermatology", "COVID-19 and skin eruption", "Coronavirus and skin rash", "COVID-19 and hair", "Coronavirus and hair", "Coronavirus and nails", "SARS-CoV-2 and hair", and "SARS-CoV-2 and nails". Only articles with abstracts referring strictly to cutaneous manifestations of COVID-19 were chosen. Articles without abstracts were not considered. RESULTS We established six of the most frequently reported clinical patterns associated with COVID-19 and their probability of occurring during COVID-19 disease evolution based on the current literature reports. We did not identify the particular types of skin lesions that are most prone to long-term persistence; most such cases are rare, and no conclusion can be drawn based on them. CONCLUSIONS Apart from classified COVID-19-related skin disorders, this pandemic has been a challenge for dermatologists and a wide range of cutaneous side effects related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) treatments have been reported. We are aware of other polymorphic clinical presentations, with novel data being reported periodically, but the pathophysiological mechanisms and evolution are largely unknown.
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Affiliation(s)
- Oana Maria Ică
- Department of Dermatology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania
| | - George Mitroi
- Department of Urology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania
| | - Simona Laura Ianoşi
- Department of Dermatology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania
| | - Cristina Violeta Tutunaru
- Department of Dermatology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania
| | - Polliana Mihaela Leru
- Department of Family Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Daniela Matei
- Department of Medical Rehabilitation, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania
| | | | - Cornelia Andreea Tănasie
- Department of Physiology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania
| | - Iulia Bianca Mitroi
- Medical Student, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania
| | - Carmen Daniela Neagoe
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania
| | - Sergiu Marian Cazacu
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania
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2
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Gehlhausen JR, Little AJ, Ko CJ, Emmenegger M, Lucas C, Wong P, Klein J, Lu P, Mao T, Jaycox J, Wang E, Ugwu N, Muenker C, Mekael D, Klein RQ, Patrignelli R, Antaya R, McNiff J, Damsky W, Kamath K, Shon J, Ring AM, Yildirim I, Omer S, Ko AI, Aguzzi A, Iwasaki A; Yale IMPACT Team. Lack of association between pandemic chilblains and SARS-CoV-2 infection. Proc Natl Acad Sci U S A 2022; 119:e2122090119. [PMID: 35217624 DOI: 10.1073/pnas.2122090119] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2022] [Indexed: 12/13/2022] Open
Abstract
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 SARS-CoV-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-CoV-2 seronegative abortive infections.
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3
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Navarro-Bielsa A, Abadías-Granado I, Morales-Callaghan AM, Suso-Estívalez C, Povar-Echeverría M, Rello L, Gilaberte Y. Experience with Cutaneous Manifestations in COVID-19 Patients during the Pandemic. J Clin Med 2022; 11:600. [PMID: 35160051 PMCID: PMC8836359 DOI: 10.3390/jcm11030600] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 01/16/2022] [Accepted: 01/21/2022] [Indexed: 02/04/2023] Open
Abstract
After the beginning of the SARS-CoV-2 pandemic, our dermatology department created a multidisciplinary unit to manage patients with cutaneous manifestations associated with COVID-19. With the objective of identifying skin lesions in patients with suspected COVID-19 and evaluating possible associations with systemic involvement, other infectious agents and coagulation disorders, we carried out a prospective observational study that included all patients that attended our COVID-19 dermatology clinic with a multidisciplinary protocol. A total of 63 patients (mean 34.6 years) were enrolled between May 2020 and February 2021. Overall, 27 patients (42.9%) had a positive COVID-19 test, and 74.6% had COVID-19 clinical signs. The most common skin lesion was maculopapular rash (36.5%), predominantly seen in male (54.2%) and older patients (42 vs. 30 years), followed by chilblain-like lesions (20.6%) in younger patients (13.9 vs. 20.9 years) who were predominantly barefoot at home (69.2%); these patients exhibited a tendency towards a negative COVID-19 test. A total of 12 patients (19.1%) had positive serology for herpesvirus 6 (IgM or IgG). We conclude that the COVID-19-associated skin lesions we observed were similar to those previously described. Questions as to the underlying mechanisms remain. Interferon, possibly aided by cold exposure, may cause perniosis-like lesions. Other cutaneous manifestations were similar to those caused by other viruses, suggesting that SARS-CoV-2 may reactivate or facilitate other viral infections.
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Affiliation(s)
- Alba Navarro-Bielsa
- Dermatology Service, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain; (I.A.-G.); (A.M.M.-C.); (Y.G.)
- IIS Aragón, Universidad de Zaragoza, 50009 Zaragoza, Spain
| | - Isabel Abadías-Granado
- Dermatology Service, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain; (I.A.-G.); (A.M.M.-C.); (Y.G.)
- IIS Aragón, Universidad de Zaragoza, 50009 Zaragoza, Spain
| | - Ana María Morales-Callaghan
- Dermatology Service, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain; (I.A.-G.); (A.M.M.-C.); (Y.G.)
- IIS Aragón, Universidad de Zaragoza, 50009 Zaragoza, Spain
| | - Catalina Suso-Estívalez
- Internal Medicine Service, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain; (C.S.-E.); (M.P.-E.)
| | - Marina Povar-Echeverría
- Internal Medicine Service, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain; (C.S.-E.); (M.P.-E.)
| | - Luis Rello
- Biochemistry Service, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain;
| | - Yolanda Gilaberte
- Dermatology Service, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain; (I.A.-G.); (A.M.M.-C.); (Y.G.)
- IIS Aragón, Universidad de Zaragoza, 50009 Zaragoza, Spain
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4
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Frumholtz L, Bouaziz JD, Battistella M, Hadjadj J, Chocron R, Bengoufa D, Le Buanec H, Barnabei L, Meynier S, Schwartz O, Grzelak L, Smith N, Charbit B, Duffy D, Yatim N, Calugareanu A, Philippe A, Guerin CL, Joly B, Siguret V, Jaume L, Bachelez H, Bagot M, Rieux-Laucat F, Maylin S, Legoff J, Delaugerre C, Gendron N, Smadja DM, Cassius C. Type I interferon response and vascular alteration in chilblain-like lesions during the COVID-19 outbreak. Br J Dermatol 2021; 185:1176-1185. [PMID: 34611893 PMCID: PMC8652826 DOI: 10.1111/bjd.20707] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2021] [Indexed: 12/14/2022]
Abstract
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.
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Affiliation(s)
- L Frumholtz
- Dermatology Department, AP-HP, Hôpital Saint-Louis, F-75010, Paris, France
| | - J-D Bouaziz
- Dermatology Department, AP-HP, Hôpital Saint-Louis, F-75010, Paris, France.,Université de Paris, Human Immunology Pathophysiology Immunotherapy, INSERM U976, Institut de Recherche Saint-Louis, F-75010, Paris, France
| | - M Battistella
- Université de Paris, Human Immunology Pathophysiology Immunotherapy, INSERM U976, Institut de Recherche Saint-Louis, F-75010, Paris, France.,Pathology Department, AP-HP, Hôpital Saint-Louis, F-75010, Paris, France
| | - J Hadjadj
- Université de Paris, Imagine Institute, Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, INSERM U1163, F-75015, Paris, France.,Department of Internal Medicine, National Reference Centre for Rare Systemic Autoimmune Diseases, AP-HP, Hôpital Cochin, F-75014, Paris, France
| | - R Chocron
- Université de Paris, PARCC, INSERM, F-75006, Paris, France.,Emergency Department, AP-HP, Georges Pompidou European Hospital, F-75015, Paris, France
| | - D Bengoufa
- Immunobiology Department, AP-HP, Hôpital Saint-Louis, F-75010, Paris, France
| | - H Le Buanec
- Université de Paris, Human Immunology Pathophysiology Immunotherapy, INSERM U976, Institut de Recherche Saint-Louis, F-75010, Paris, France
| | - L Barnabei
- Université de Paris, Imagine Institute, Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, INSERM U1163, F-75015, Paris, France
| | - S Meynier
- Université de Paris, Imagine Institute, Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, INSERM U1163, F-75015, Paris, France
| | - O Schwartz
- Institut Pasteur, Virus and Immunity Unit, F-75015, Paris, France
| | - L Grzelak
- Institut Pasteur, Virus and Immunity Unit, F-75015, Paris, France
| | - N Smith
- Institut Pasteur, Translational Immunology Lab, F-75015, Paris, France
| | - B Charbit
- Institut Pasteur, Cytometry and Biomarkers UTechS, CRT, F-75015, Paris, France
| | - D Duffy
- Institut Pasteur, Translational Immunology Lab, F-75015, Paris, France.,Institut Pasteur, Cytometry and Biomarkers UTechS, CRT, F-75015, Paris, France
| | - N Yatim
- Dermatology Department, AP-HP, Hôpital Saint-Louis, F-75010, Paris, France.,Institut Pasteur, Translational Immunology Lab, F-75015, Paris, France
| | - A Calugareanu
- Dermatology Department, AP-HP, Hôpital Saint-Louis, F-75010, Paris, France.,Université de Paris, Human Immunology Pathophysiology Immunotherapy, INSERM U976, Institut de Recherche Saint-Louis, F-75010, Paris, France
| | - A Philippe
- Institut Pasteur, Cytometry and Biomarkers UTechS, CRT, F-75015, Paris, France
| | - C L Guerin
- Université de Paris, Innovative Therapies in Haemostasis, INSERM, F-75006, Paris, France.,Institut Curie, Cytometry Platform, F-75006, Paris, France
| | - B Joly
- Biological Haematology Department, AP-HP, Hôpital Lariboisière, F-75010, Paris, France.,Université de Paris, EA3518, Institut de Recherche Saint-Louis, F-75010, Paris, France
| | - V Siguret
- Biological Haematology Department, AP-HP, Hôpital Lariboisière, F-75010, Paris, France.,Université de Paris, INSERM UMR S1140, F-75010, Paris, France
| | - L Jaume
- Dermatology Department, AP-HP, Hôpital Saint-Louis, F-75010, Paris, France
| | - H Bachelez
- Dermatology Department, AP-HP, Hôpital Saint-Louis, F-75010, Paris, France.,Université de Paris, Imagine Institute, Laboratory of Genetics of Skin Diseases, INSERM U1163, F-75015, Paris, France
| | - M Bagot
- Dermatology Department, AP-HP, Hôpital Saint-Louis, F-75010, Paris, France.,Université de Paris, Human Immunology Pathophysiology Immunotherapy, INSERM U976, Institut de Recherche Saint-Louis, F-75010, Paris, France
| | - F Rieux-Laucat
- Université de Paris, Imagine Institute, Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, INSERM U1163, F-75015, Paris, France
| | - S Maylin
- Virology Department, AP-HP, Hôpital Saint-Louis, F-75010, Paris, France
| | - J Legoff
- Virology Department, AP-HP, Hôpital Saint-Louis, F-75010, Paris, France.,Université de Paris, Team Insight, INSERM U976, Institut de Recherche Saint-Louis, F-75010, Paris, France
| | - C Delaugerre
- Virology Department, AP-HP, Hôpital Saint-Louis, F-75010, Paris, France
| | - N Gendron
- Université de Paris, Innovative Therapies in Haemostasis, INSERM, F-75006, Paris, France.,Hematology Department and Biosurgical Research Lab (Carpentier Foundation), Assistance Publique Hôpitaux de Paris-Centre Université de Paris (APHP-CUP), F-75015, Paris, France
| | - D M Smadja
- Université de Paris, Innovative Therapies in Haemostasis, INSERM, F-75006, Paris, France.,Hematology Department and Biosurgical Research Lab (Carpentier Foundation), Assistance Publique Hôpitaux de Paris-Centre Université de Paris (APHP-CUP), F-75015, Paris, France
| | - C Cassius
- Dermatology Department, AP-HP, Hôpital Saint-Louis, F-75010, Paris, France.,Université de Paris, Human Immunology Pathophysiology Immunotherapy, INSERM U976, Institut de Recherche Saint-Louis, F-75010, Paris, France
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5
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Abstract
Many skin manifestations of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection reflect activation of cutaneous and systemic immune responses involving effector pathways of both the innate and adaptive arms of the immune system. This article reviews evidence from the recent clinical and scientific literature that informs the current understanding of the consequences of coronavirus disease 2019 (COVID-19)-induced immune cell activation, as relevant to dermatology. Topics include the clinical consequences of autoantibody production in patients with COVID-19, immunologic evidence for chilblains as a manifestation of SARS-CoV-2 infection, and the relationship between type I interferons and COVID-19 disease severity.
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Affiliation(s)
- Antonia E Gallman
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA; Medical Scientist Training Program, University of California, San Francisco, 513 Parnassus Avenue, Room HSE1001A, San Francisco, CA 94143, USA
| | - Marlys S Fassett
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA; Department of Dermatology, University of California, San Francisco, 513 Parnassus Avenue, Room HSE1001E, San Francisco, CA 94143, USA.
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6
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Sánchez-García V, Hernández-Quiles R, de-Miguel-Balsa E, Docampo-Simón A, Belinchón-Romero I, Ramos-Rincón JM. Are the chilblain-like lesions observed during the COVID-19 pandemic due to severe acute respiratory syndrome coronavirus 2? Systematic review and meta-analysis. J Eur Acad Dermatol Venereol 2021; 36:24-38. [PMID: 34545625 PMCID: PMC8657348 DOI: 10.1111/jdv.17672] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/05/2021] [Accepted: 08/10/2021] [Indexed: 01/07/2023]
Abstract
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 severe acute respiratory syndrome coronavirus 2 (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: (i) positive PCR: 2.6% [95% confidence interval (CI) 1.9% to 3.4%] and 5.5% (95% CI, 3.7–7.7%); (ii) positive serology for SARS‐CoV‐2: 7.2% (95% CI, 4.7–10.2%) and 11.8% (95% CI, 7.9–16.3%); and (iii) positive PCR and/or serology, 15.2% (95% CI, 10.4–20.7%) and 7.5% (95% CI, 5.1–10.3%). Altogether, a small proportion of diagnostic tests for SARS‐CoV‐2, both PCR and serologies, show positive results in patients with CLL.
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Affiliation(s)
- V Sánchez-García
- Dermatology Department, Alicante University General Hospital-ISABIAL, Alicante, Spain
| | - R Hernández-Quiles
- Dermatology Department, Alicante University General Hospital-ISABIAL, Alicante, Spain
| | - E de-Miguel-Balsa
- Intensive Care Department, Elche University General Hospital, Alicante, Spain.,Clinical Medicine Department, University Miguel Hernández of Elche, Alicante, Spain
| | - A Docampo-Simón
- Dermatology Department, Alicante University General Hospital-ISABIAL, Alicante, Spain
| | - I Belinchón-Romero
- Dermatology Department, Alicante University General Hospital-ISABIAL, Alicante, Spain.,Clinical Medicine Department, University Miguel Hernández of Elche, Alicante, Spain
| | - J M Ramos-Rincón
- Clinical Medicine Department, University Miguel Hernández of Elche, Alicante, Spain.,Internal Medicine Department, Alicante University General Hospital-ISABIAL, Alicante, Spain
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7
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Wollina U, Kanitakis J, Baran R. Nails and COVID-19 - A comprehensive review of clinical findings and treatment. Dermatol Ther 2021; 34:e15100. [PMID: 34398500 PMCID: PMC8420555 DOI: 10.1111/dth.15100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/01/2021] [Accepted: 08/13/2021] [Indexed: 12/19/2022]
Abstract
The SARS‐CoV‐2 infection, responsible for COVID‐19, has raised the interest for infection‐associated muco‐cutaneous symptoms. While dermatologic symptoms in general gained an increasing awareness, affection of the nail organ has been mentioned only recently. We provide a narrative review on COVID‐19 manifestation on the nail organ and add symptoms induced by personal protective measures and SARS‐CoV‐2 vaccination. Available treatment options are discussed.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Dresden, Germany
| | - Jean Kanitakis
- Dermatology Department, Edouard Herriot Hospital Group, (Pav. R), Hospices Civils de Lyon, Lyon, France
| | - Robert Baran
- Dermatology, Nail Disease Center, Cannes, France
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8
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Cassius C, Merandet M, Frumholtz L, Bergerat D, Samri A, Grolleau C, Grzelak L, Schwartz O, Yatim N, Moghadam P, Jaume L, Bagot M, Legoff J, Delaugerre C, Bouaziz JD, Le Buanec H. Analysis of T cell responses directed against the spike and/or membrane and/or nucleocapsid proteins in chilblain-like lesions patients during the COVID-19 pandemic. Br J Dermatol 2021; 185:1242-1244. [PMID: 34258762 PMCID: PMC8444844 DOI: 10.1111/bjd.20647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/12/2021] [Accepted: 07/12/2021] [Indexed: 11/27/2022]
Affiliation(s)
- C Cassius
- Dermatology department, AP-HP, Hôpital Saint-Louis, F-75010, Paris, France.,Université de Paris, Human immunology Pathophysiology Immunotherapy, INSERM U976, Institut de Recherche Saint-Louis, F-75010, Paris, France
| | - M Merandet
- Université de Paris, Human immunology Pathophysiology Immunotherapy, INSERM U976, Institut de Recherche Saint-Louis, F-75010, Paris, France
| | - L Frumholtz
- Dermatology department, AP-HP, Hôpital Saint-Louis, F-75010, Paris, France
| | - D Bergerat
- Université de Paris, Human immunology Pathophysiology Immunotherapy, INSERM U976, Institut de Recherche Saint-Louis, F-75010, Paris, France
| | - A Samri
- Sorbonne Université, Inserm 1135, Centre d'immunologie et des maladies infectieuses, Cimi-Paris, F-75013, Paris, France
| | - C Grolleau
- Dermatology department, AP-HP, Hôpital Saint-Louis, F-75010, Paris, France.,Université de Paris, Human immunology Pathophysiology Immunotherapy, INSERM U976, Institut de Recherche Saint-Louis, F-75010, Paris, France
| | - L Grzelak
- Institut Pasteur, Virus and immunity unit, F-75015, Paris, France
| | - O Schwartz
- Institut Pasteur, Virus and immunity unit, F-75015, Paris, France
| | - N Yatim
- Dermatology department, AP-HP, Hôpital Saint-Louis, F-75010, Paris, France.,Institut Pasteur, Translational Immunology Lab, F-75015, Paris, France
| | - P Moghadam
- Dermatology department, AP-HP, Hôpital Saint-Louis, F-75010, Paris, France
| | - L Jaume
- Dermatology department, AP-HP, Hôpital Saint-Louis, F-75010, Paris, France
| | - M Bagot
- Dermatology department, AP-HP, Hôpital Saint-Louis, F-75010, Paris, France.,Université de Paris, Human immunology Pathophysiology Immunotherapy, INSERM U976, Institut de Recherche Saint-Louis, F-75010, Paris, France
| | - J Legoff
- Virology Department, AP-HP, Hôpital Saint-Louis, F-75010, Paris, France.,Université de Paris, Team Insight, INSERM U976, Institut de Recherche Saint-Louis, F-75010, Paris, France
| | - C Delaugerre
- Virology Department, AP-HP, Hôpital Saint-Louis, F-75010, Paris, France
| | - J-D Bouaziz
- Dermatology department, AP-HP, Hôpital Saint-Louis, F-75010, Paris, France.,Université de Paris, Human immunology Pathophysiology Immunotherapy, INSERM U976, Institut de Recherche Saint-Louis, F-75010, Paris, France
| | - H Le Buanec
- Université de Paris, Human immunology Pathophysiology Immunotherapy, INSERM U976, Institut de Recherche Saint-Louis, F-75010, Paris, France
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9
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Carazo Gallego B, Martín Pedraz L, Galindo Zavala R, Rivera Cuello M, Mediavilla Gradolph C, Núñez Cuadros E. Skin lesions in children during the first wave of the SARS-CoV-2 pandemic. Med Clin (Engl Ed) 2021; 157:33-37. [PMID: 34151022 PMCID: PMC8196301 DOI: 10.1016/j.medcle.2021.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/05/2021] [Indexed: 11/25/2022]
Abstract
Background Cutaneous manifestations have been included in COVID-19 patients’ clinical spectrum. Our objective was to determine the association between skin lesions in children and SARS-CoV2 infection, analyzing others possible infectious/autoimmune etiologies. Material and methods Observational, multicenter, cross-sectional study, about children with skin manifestations from April to May 2020. The diagnosis of SARS-CoV2 was performed by PCR in nasopharyngeal exudate and/or presence of antibodies by serology. Results Sixty-two children were included, 9 (14.5%) presented positive antibodies to SARS-CoV-2, with no positive PCR to SARS-Cov-2 in those patients in whom it was made. Patients with positive serology to SARS-CoV-2 presented chilblains and/or vesicular-bullous skin lesions more frequently (66.7% vs. 24.5%, p = 0.019). Generalized, urticarial and maculopapular rash was more common in patients with negative antibodies (37.7 vs. 0%, p = 0.047), others pathogens were isolated in 41.5% of these patients. There were no significant differences in the positivity for autoantibodies between both groups. Conclusion In our study, the presence of chilblains-like and/or vesicular lesions were significantly related to SARS-CoV2 previous contact.
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Affiliation(s)
- Begoña Carazo Gallego
- Unidad de Infectología Pediátrica, UGC Pediatría, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Laura Martín Pedraz
- Unidad de Infectología Pediátrica, UGC Pediatría, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Rocío Galindo Zavala
- Unidad de Reumatología Pediátrica, UGC Pediatría, Hospital Regional Universitario de Málaga, Málaga, Spain
| | | | | | - Esmeralda Núñez Cuadros
- Unidad de Reumatología Pediátrica, UGC Pediatría, Hospital Regional Universitario de Málaga, Málaga, Spain
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10
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Carazo Gallego B, Martín Pedraz L, Galindo Zavala R, Rivera Cuello M, Mediavilla Gradolph C, Núñez Cuadros E. [Skin lesions in children during the first wave of the SARS-CoV-2 pandemic]. Med Clin (Barc) 2021; 157:33-37. [PMID: 34016448 PMCID: PMC8096168 DOI: 10.1016/j.medcli.2021.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 01/22/2023]
Abstract
Introducción Las manifestaciones cutáneas se han incluido en el espectro clínico de los pacientes con COVID-19. Nuestro objetivo fue determinar la asociación entre las lesiones cutáneas observadas en niños durante la primera ola de la pandemia y la infección por SARS-CoV-2, analizando otras posibles etiologías infecciosas o autoinmunes. Material y métodos Estudio observacional, multicéntrico, de corte transversal, desarrollado en niños con manifestaciones cutáneas desde abril hasta mayo de 2020. La determinación de SARS-CoV-2 se realizó mediante PCR en exudado nasofaríngeo y/o serología. Resultados Se seleccionó a 62 niños; 9 (14,5%) presentaron serología positiva para SARS-CoV-2, siendo la PCR negativa en todos los casos en los que se realizó. Los pacientes con serología positiva para SARS-CoV-2 presentaron con más frecuencia lesiones pernióticas y/o vesiculosas (66,7 vs. 24,5%; p = 0,019). El exantema generalizado, urticarial y maculopapuloso fue más habitual en el grupo de pacientes con serología negativa (37,7 vs. 0%; p = 0,047); se aislaron otros patógenos en el 41,5%. No hubo diferencias significativas en cuanto a la positividad de autoanticuerpos entre ambos grupos. Conclusión En nuestro estudio, las lesiones de tipo perniosis o vesiculosas se relacionaron significativamente con el contacto previo con SARS-CoV-2.
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Affiliation(s)
- Begoña Carazo Gallego
- Unidad de Infectología Pediátrica, UGC Pediatría, Hospital Regional Universitario de Málaga, Málaga, España.
| | - Laura Martín Pedraz
- Unidad de Infectología Pediátrica, UGC Pediatría, Hospital Regional Universitario de Málaga, Málaga, España
| | - Rocío Galindo Zavala
- Unidad de Reumatología Pediátrica, UGC Pediatría, Hospital Regional Universitario de Málaga, Málaga, España
| | | | | | - Esmeralda Núñez Cuadros
- Unidad de Reumatología Pediátrica, UGC Pediatría, Hospital Regional Universitario de Málaga, Málaga, España
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Abstract
Warts are regularly treated by dermatologists, and while many respond readily to first-line treatments, others may represent a therapeutic challenge. Large, deep, numerous, and extensive warts; treatment-resistant lesions with higher risk for side effects, such as hypopigmentation; or patients unable to tolerate or comply with our treatment regimen, may need alternative treatment options. In this work we review the characteristics of select modalities that should be considered for difficult-to-treat warts. We discuss efficacy and tolerability data as well as practical features that can guide us to select the best treatment for every scenario. Novel approaches, still in an investigational phase, are also discussed to illustrate potential future directions of wart treatment.
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Cassius C, Frumholtz L, de Masson A, Dadzie O, Petit A. Under-representation of people of African ancestry in publications on the cutaneous manifestations of COVID-19: coincidence or physiology? J Eur Acad Dermatol Venereol 2021; 35:e480-e481. [PMID: 33866618 PMCID: PMC8250510 DOI: 10.1111/jdv.17289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/13/2021] [Indexed: 12/01/2022]
Affiliation(s)
- C Cassius
- Dermatology Department, AP-HP, Hôpital Saint-Louis, Paris, France.,Human immunology Pathophysiology Immunotherapy, INSERM U976, Institut de Recherche Saint-Louis, Université de Paris, Paris, France
| | - L Frumholtz
- Dermatology Department, AP-HP, Hôpital Saint-Louis, Paris, France
| | - A de Masson
- Dermatology Department, AP-HP, Hôpital Saint-Louis, Paris, France.,Human immunology Pathophysiology Immunotherapy, INSERM U976, Institut de Recherche Saint-Louis, Université de Paris, Paris, France
| | - O Dadzie
- Department of Cellular Pathology, North West London Pathology, Imperial College Healthcare NHS Trust, London, UK.,Department of Dermatology, The Hillingdon Hospitals NHS Foundation Trust, London, UK
| | - A Petit
- Dermatology Department, AP-HP, Hôpital Saint-Louis, Paris, France
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13
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Jindal R, Chauhan P, Goyal D, Shirazi N. Idiopathic perniosis presenting as acral purpuric lesions: Clustering of cases before COVID-19 pandemic and their comparison with chilblain like lesions reported in the literature. Dermatol Ther 2021; 34:e14951. [PMID: 33740317 PMCID: PMC8250052 DOI: 10.1111/dth.14951] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 02/16/2021] [Accepted: 03/11/2021] [Indexed: 11/29/2022]
Abstract
Perniosis/chilblains are the acral inflammatory skin lesions developing in susceptible individuals as an abnormal reaction to cold. In the absence of a discernible cause, it is labeled as idiopathic perniosis (IP). With the ongoing COVID-19 pandemic, there was an upsurge of reports of chilblain like lesions (CLL) especially in young patients possibly implicated to the SARS-CoV-2 virus. Twelve clinically suspected and histopathologically confirmed cases of IP seen from November 2019 through February 2020 were retrospectively recruited. Clinical, dermoscopic, and histopathological characteristics of these were reviewed and compared with CLL reported in the literature. Mean age of patients was 26.58 ± 15.18 years with an equal male to female ratio. Characteristic histopathology findings were spongiosis (100%), dermal edema (100%), perivascular lymphocytic infiltrate (100%) with peri-eccrine accentuation (66.7%), keratinocyte necrosis (50%), focal basal vacuolar damage (58.3%), and lymphocytic vasculitis (58.3%). Significant dermoscopy findings were variable background color ranging from dull red and violaceous to copper red and brown orange, coiled vessels (44.4%) and orange-red structureless areas (63.9%). Lesions over palms and soles preferentially had white dots/clods and lines (38.9%). There appears no exclusive histopathological as well as dermoscopy features of CLL and IP, yet certain clues can be appreciated. Keratinocyte necrosis and severe dermal edema favors IP, whereas fibrin thrombi with involvement of both superficial and deep dermal vessels favor CLL. Dermoscopically presence of irregular, linear or branching vessels, red/purple dots and clods and gray brown reticule supports CLL while white dots/clods and lines supports IP.
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Affiliation(s)
- Rashmi Jindal
- Department of Dermatology, Venereology and Leprosy, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, India
| | - Payal Chauhan
- Department of Dermatology, Venereology and Leprosy, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, India
| | - Dikshita Goyal
- Department of Dermatology, Venereology and Leprosy, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, India
| | - Nadia Shirazi
- Department of Pathology, HIHT University, Dehradun, India
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Drouot L, Hantz S, Jouen F, Velay A, Lamia B, Veber B, Sibilia J, Lotellier M, Candon S, Alain S, Fafi-Kremer S, Boyer O. Evaluation of Humoral Immunity to SARS-CoV-2: Diagnostic Value of a New Multiplex Addressable Laser Bead Immunoassay. Front Microbiol 2020; 11:603931. [PMID: 33324387 PMCID: PMC7726470 DOI: 10.3389/fmicb.2020.603931] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 10/26/2020] [Indexed: 12/17/2022] Open
Abstract
Despite efforts to develop anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody (Ab) immunoassays, reliable serological methods are still needed. We developed a multiplex addressable laser bead immunoassay (ALBIA) to detect and quantify anti-Spike S1 and nucleocapsid N Abs. Recombinant S1 and N proteins were bound to fluorescent beads (ALBIA-IgG-S1/N). Abs were revealed using class-specific anti-human Ig Abs. The performances of the test were analyzed on 575 serum samples including 192 from SARS-CoV-2 polymerase chain reaction-confirmed patients, 13 from seasonal coronaviruses, 70 from different inflammatory/autoimmune diseases, and 300 from healthy donors. Anti-S1 IgM were detected by monoplex ALBIA-IgM-S1. Comparison with chemiluminescent assays or enzyme-linked immunosorbent assays was performed using commercial tests. Multiplex ALBIA-IgG-S1/N was effective in detecting and quantifying anti-SARS-CoV-2 IgG Abs. Two weeks after first symptoms, sensitivity and specificity were 97.7 and 98.0% (anti-S1), and 100 and 98.7% (anti-N), respectively. Agreement with commercial tests was good to excellent, with a higher sensitivity of ALBIA. ALBIA-IgG-S1/N was positive in 53% of patients up to day 7, and in 75% between days 7 and 13. For ALBIA-IgM-S1, sensitivity and specificity were 74.4 and 98.7%, respectively. Patients in intensive care units had higher IgG Ab levels (Mann-Whitney test, p < 0.05). ALBIA provides a robust method for exploring humoral immunity to SARS-CoV-2. Serology should be performed after 2 weeks following first symptoms, when all COVID-19 (coronavirus disease 2019) patients had at least one anti-S1 or anti-N IgG Ab, illustrating the interest of a multiplex test.
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Affiliation(s)
- Laurent Drouot
- Normandie University, UNIROUEN, INSERM, U1234, Rouen, France
| | - Sébastien Hantz
- Limoges University Hospital, National Reference Center for Herpesviruses, Limoges, France
| | - Fabienne Jouen
- Normandie University, UNIROUEN, INSERM, U1234, Rouen, France.,Rouen University Hospital, Department of Immunology, Rouen, France
| | - Aurélie Velay
- Strasbourg University Hospital, Institute of Virology, Strasbourg, France
| | - Bouchra Lamia
- Pulmonology Department, Le Havre Hospital, Montivilliers, France
| | - Benoit Veber
- Department of Anesthesiology and Critical Care, Rouen University Hospital, Rouen, France
| | - Jean Sibilia
- Department of Rheumatology, Strasbourg University Hospital, Strasbourg, France
| | | | - Sophie Candon
- Normandie University, UNIROUEN, INSERM, U1234, Rouen, France.,Rouen University Hospital, Department of Immunology, Rouen, France
| | - Sophie Alain
- Limoges University Hospital, National Reference Center for Herpesviruses, Limoges, France
| | - Samira Fafi-Kremer
- Strasbourg University Hospital, Institute of Virology, Strasbourg, France
| | - Olivier Boyer
- Normandie University, UNIROUEN, INSERM, U1234, Rouen, France.,Rouen University Hospital, Department of Immunology, Rouen, France
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Kluger N. Why are chilblains underreported in Nordic countries during the COVID-19 pandemic? An analysis of Google Trends. J Eur Acad Dermatol Venereol 2020; 35:e100-e101. [PMID: 33010073 PMCID: PMC7675374 DOI: 10.1111/jdv.16974] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- N Kluger
- Departments of Dermatology, Allergology and Venereology, Helsinki University Hospital, Helsinki, Finland
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