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    1 Comment for this article
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    Chilblains in the SARS-CoV-2 infections more research is needed
    GIOVANNI GHIRGA |
    The authors conclude that chilblains appeared not to be directly associated with COVID-19 in their case series and perhaps prematurely postulate lifestyle changes associated with community containment and lockdown measures are a possible explanation. Coming to the aid of the frequent clinical suspect of SARS-CoV-2 role in the acral lesions are the results of detailed histopathological descriptions of COVID-19 chilblains.

    Purpura, superficial and deep perivascular lymphocytic inflammation with perieccrine accentuation, oedema, and mild vacuolar interface damage were reported. SARS-CoV-2 immunohistochemistry was positive in endothelial cells and epithelial cells of eccrine glands. Coronavirus particles were found in the cytoplasm of
    endothelial cells on electron microscopy.

    The explanation of different results is to date e mystery.

    Colmenero I, Santonja C, Alonso-Riaño M, et al. SARS-CoV-2 endothelial infection causes COVID-19 chilblains: a histopathological, immunohistochemical and ultrastructural study of 7 paediatric cases [published online ahead of print, 2020 Jun 20]. Br J Dermatol. 2020;10.1111/bjd.19327.

    Giovanni Ghirga, Pediatrician, Civitavecchia, Italy
    CONFLICT OF INTEREST: None Reported
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    Views 11,192
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    Brief Report
    June 25, 2020

    Evaluation of Chilblains as a Manifestation of the COVID-19 Pandemic

    Author Affiliations
    • 1Department of Dermatology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
    • 2Pneumology, ENT, and Dermatology Pole, Institute of Experimental and Clinical Research, Université Catholique de Louvain, Brussels, Belgium
    • 3Department of Laboratory Medicine, Division of Microbiology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
    • 4Department of Anatomopathology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
    • 5Department of Laboratory Medicine, Division of Clinical Biochemistry, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
    • 6Department of Internal Medicine, Division of Hematology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
    JAMA Dermatol. Published online June 25, 2020. doi:10.1001/jamadermatol.2020.2368
    Key Points

    Question  Is there an association between chilblains and coronavirus disease 2019 (COVID-19)?

    Findings  In this case series of 31 patients who had recently developed chilblains, none of the patients tested positive for COVID-19 on nasopharyngeal swabs, nor were blood immunoglobulin (Ig) M or IgG antibodies detected.

    Meaning  These ischemic, acral cutaneous lesions appeared not to be directly associated with COVID-19.

    Abstract

    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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