Subject(s)
COVID-19 , Chilblains , Biopsy , Chilblains/diagnosis , Child , Family , Humans , SARS-CoV-2Subject(s)
COVID-19 , Dermatitis, Exfoliative/diagnosis , Foot Dermatoses/diagnosis , Hand Dermatoses/diagnosis , Child, Preschool , Female , Humans , Infant , MaleABSTRACT
During the SARS-CoV-2 (COVID-19) pandemic, an unusual outbreak of yellow-brown pigmentation on the skin of children was reported. Because of the restrictions on movement promulgated during the lockdown, most consultancies were performed using teledermatology. Data concerning personal care products and application of topical substances were collected, which revealed use of the same brand of wipes for all patients. A liquid chromatography-mass spectrometry analysis was performed to compare the components of the wipes before and after the observation of the pigmentation, in order to detect the responsible substance. This analysis revealed a level about 10-fold higher than normal of ascorbic acid and its oxidation products (dehydroascorbic acid and L-threonic acid) in the wipes associated with the pigmentation. These 'colouring wipes' represent a peculiar but harmless phenomenon that highlights the importance of careful questioning about personal care products used by patients.
Subject(s)
Ascorbic Acid/adverse effects , COVID-19/epidemiology , Pandemics , Quarantine , Skin Pigmentation/drug effects , Skin/pathology , Child, Preschool , Female , Humans , Infant , Male , Mass Spectrometry , Vitamins/adverse effectsSubject(s)
COVID-19 , Chilblains , COVID-19 Vaccines , Chilblains/etiology , Humans , RNA, Messenger , SARS-CoV-2Subject(s)
Coronavirus Infections/epidemiology , Erythema/diagnosis , Exanthema/pathology , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Skin Diseases, Viral/pathology , Biopsy, Needle , COVID-19 , Comorbidity , Coronavirus Infections/diagnosis , Diagnosis, Differential , Erythema/epidemiology , Exanthema/diagnosis , Exanthema/epidemiology , Female , Humans , Immunohistochemistry , Incidence , Italy/epidemiology , Male , Pneumonia, Viral/diagnosis , Risk Assessment , Severe Acute Respiratory Syndrome/diagnosis , Severe Acute Respiratory Syndrome/epidemiology , Skin Diseases, Viral/diagnosis , Skin Diseases, Viral/epidemiologyABSTRACT
BACKGROUND: Over the last months, during the COVID-19 pandemic, a growing number of chilblain-like lesions were reported mainly in children and rarely in young adults. The relationship with SARS-CoV-2 infection was postulated, often without any laboratory, instrumental or clinical confirmation. The disclosure of information about chilblain-like lesions as a COVID-19 manifestation in social media has created concern in children's families and paediatricians. OBJECTIVES: To verify whether the chilblain-like lesions were caused by SARS-CoV-2 infection. METHODS: Prospective study on a case series including children who presented with acral lesions at the Pediatric Dermatology Outpatient and Pediatric Emergency Unit of the University of Bologna, from 1 April to 30 April 2020. We reported demographical, laboratory and clinical features, history of close contact with COVID-19 patients, presence of similar skin lesions in other family members, precipitating and risk factors for chilblain onset. RESULTS: We evaluated eight patients (five females, three males) aged between 11 and 15 years. We excluded acute or previous SARS-CoV-2 infection with RT-PCR nasopharyngeal swab, serum antibody levels using chemiluminescent immunoassays. Other acute infections causing purpuric lesions at the extremities were negative in all patients. Skin lesion biopsy for histological and immunohistochemical evaluation was made in two cases and was consistent with chilblain. PCR assay on skin lesion biopsy for parvovirus B19, Mycoplasma pneumoniae and SARS-CoV-2 was performed in a patient and resulted negative. We identified common precipitating and risk factors: physical (cold and wet extremities, low BMI), cold and wet indoor and outdoor environment, behaviours, habits and lifestyle. We therefore reached a diagnosis of primary chilblains. CONCLUSIONS: During the COVID-19 pandemic, a 'cluster' of primary chilblains developed in predisposed subjects, mainly teenagers, due to cold exposure in the lockdown period. Laboratory findings support our hypothesis, although it is also possible that an unknown infectious trigger may have contributed to the pathogenesis.