A clinicopathological description of COVID‐19‐induced chilblains (COVID‐toes) correlated with a published literature review
A Kolivras, C Thompson, I Pastushenko… - Journal of cutaneous …, 2022 - Wiley Online Library
A Kolivras, C Thompson, I Pastushenko, M Mathieu, P Bruderer, M de Vicq, F Feoli, S Harag…
Journal of cutaneous pathology, 2022•Wiley Online LibraryBackground 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 …
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 …
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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