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COVID 19-associated chilblain-like acral lesions among children and adolescents: an Italian retrospective, multicenter study.
Romita, Paolo; Maronese, Carlo A; DE Marco, Aurora; Balestri, Riccardo; Belloni Fortina, Anna; Brazzelli, Valeria; Colonna, Cristiana; DI Lernia, Vito; El Hachem, May; Fabbrocini, Gabriella; Foti, Caterina; Frasin, Lucretia A; Guarneri, Claudio; Guerriero, Cristina; Guida, Stefania; Locatelli, Andrea; Neri, Iria; Occella, Corrado; Offidani, Annamaria; Oranges, Teresa; Pellacani, Giovanni; Stinco, Giuseppe; Stingeni, Luca; Barbagallo, Tania; Campanati, Anna; Cannavò, Serafinella P; Caroppo, Francesca; Cavalli, Riccardo; Costantini, Alessio; Cucchia, Rosa; Diociaiuti, Andrea; Filippeschi, Cesare; Francomano, Mariangela; Giancristoforo, Simona; Giuffrida, Roberta; Martina, Emanuela; Monzani, Nicola A; Nappa, Paola; Pastorino, Carlotta; Patrizi, Annalisa; Peccerillo, Francesca; Peris, Ketty; Recalcati, Sebastiano; Rizzoli, Laura; Simonetti, Oriana; Vastarella, Maria; Virdi, Annalucia; Marzano, Angelo V; Bonamonte, Domenico.
  • Romita P; Unit of Dermatology, Department of Precision and Regenerative Medicine and Jonian Area, University of Bari, Bari, Italy.
  • Maronese CA; Unit of Dermatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
  • DE Marco A; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
  • Balestri R; Unit of Dermatology, Department of Precision and Regenerative Medicine and Jonian Area, University of Bari, Bari, Italy.
  • Belloni Fortina A; Division of Dermatology, Santa Chiara Hospital, Trento, Italy.
  • Brazzelli V; Unit of Pediatric Dermatology, Department of Medicine, University of Padua, Padua, Italy.
  • Colonna C; Institute of Dermatology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, University of Pavia, Pavia, Italy.
  • DI Lernia V; Unit of Dermatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
  • El Hachem M; Unit of Dermatology, Arcispedale Santa Maria Nuova, Azienda USL-IRCCS, Reggio Emilia, Italy.
  • Fabbrocini G; Unit of Dermatology and Genodermatosis, Division of Genetics and Rare Diseases Research, Bambino Gesù Children's Hospital, Rome, Italy.
  • Foti C; Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.
  • Frasin LA; Unit of Dermatology, Department of Precision and Regenerative Medicine and Jonian Area, University of Bari, Bari, Italy.
  • Guarneri C; Unit of Dermatology, ASTT Lecco, Alessandro Manzoni Hospital, Lecco, Italy.
  • Guerriero C; Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
  • Guida S; Institute of Dermatology, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy.
  • Locatelli A; Unit of Dermatology, Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy.
  • Neri I; Unit of Dermatology, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy.
  • Occella C; Unit of Dermatology, IRCSS Policlinico di S. Orsola, Bologna, Italy.
  • Offidani A; Unit of Dermatology, Giannina Gaslini Institute, Genoa, Italy.
  • Oranges T; Dermatological Clinic, Polytechnic Marche University, Ancona, Italy.
  • Pellacani G; Unit of Dermatology, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy.
  • Stinco G; Unit of Dermatology, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University, Rome, Italy.
  • Stingeni L; Department of Experimental and Clinical Medicine, Institute of Dermatology, University of Udine, Udine, Italy.
  • Barbagallo T; Section of Dermatology, Department of Medicine, University of Perugia, Perugia, Italy.
  • Campanati A; Unit of Dermatology, ASTT Lecco, Alessandro Manzoni Hospital, Lecco, Italy.
  • Cannavò SP; Dermatological Clinic, Polytechnic Marche University, Ancona, Italy.
  • Caroppo F; Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
  • Cavalli R; Unit of Pediatric Dermatology, Department of Medicine, University of Padua, Padua, Italy.
  • Costantini A; Unit of Dermatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
  • Cucchia R; Institute of Dermatology, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy.
  • Diociaiuti A; Section of Dermatology, Department of Medicine, University of Perugia, Perugia, Italy.
  • Filippeschi C; Unit of Dermatology and Genodermatosis, Division of Genetics and Rare Diseases Research, Bambino Gesù Children's Hospital, Rome, Italy.
  • Francomano M; Unit of Dermatology, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy.
  • Giancristoforo S; Unit of Dermatology, Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy.
  • Giuffrida R; Unit of Dermatology and Genodermatosis, Division of Genetics and Rare Diseases Research, Bambino Gesù Children's Hospital, Rome, Italy.
  • Martina E; Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
  • Monzani NA; Dermatological Clinic, Polytechnic Marche University, Ancona, Italy.
  • Nappa P; Unit of Neonatal Intensive Care, Department of Clinical Sciences and Community Health, IRCCS Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
  • Pastorino C; Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.
  • Patrizi A; Unit of Dermatology, Giannina Gaslini Institute, Genoa, Italy.
  • Peccerillo F; Unit of Dermatology, IRCSS Policlinico di S. Orsola, Bologna, Italy.
  • Peris K; Unit of Dermatology, Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy.
  • Recalcati S; Institute of Dermatology, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy.
  • Rizzoli L; Unit of Dermatology, ASTT Lecco, Alessandro Manzoni Hospital, Lecco, Italy.
  • Simonetti O; Division of Dermatology, Santa Chiara Hospital, Trento, Italy.
  • Vastarella M; Dermatological Clinic, Polytechnic Marche University, Ancona, Italy.
  • Virdi A; Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.
  • Marzano AV; Unit of Dermatology, IRCSS Policlinico di S. Orsola, Bologna, Italy.
  • Bonamonte D; Unit of Dermatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Ital J Dermatol Venerol ; 158(2): 117-123, 2023 04.
Article in English | MEDLINE | ID: covidwho-2318688
ABSTRACT

BACKGROUND:

Since the COVID-19 pandemic started, great interest has been given to this disease, especially to its possible clinical presentations. Besides classical respiratory symptoms, dermatological manifestations occur quite often among infected and non-infected patients, particularly in children. A prominent IFN-I response, that is generally higher in children compared to adults, may not only cause chilblain lesions, but it could also prevent infection and viral replication, thus justifying the negative swab results, as well as the absence of relevant systemic symptoms in positive cases. Indeed, reports have emerged describing chilblain-like acral lesions in children and adolescents with either proven or suspected infection.

METHODS:

Patients aged from 1 to 18 years old were enrolled in this study from 23 Italian dermatological units and were observed for an overall period of 6 months. Clinical pictures were collected along with data on the location and duration of skin lesions, their association with concomitant local and systemic symptoms, presence of nail and/or mucosal involvement, as well as histological, laboratory and imaging findings.

RESULTS:

One hundred thirty-seven patients were included, of whom 56.9% were females. Mean age was 11.97±3.66 years. The most commonly affected sites were the feet (77 patients, 56.2%). Lesions (48.5%) featured cyanosis, chilblains, blisters, ecchymosis, bullae, erythema, edema, and papules. Concomitant skin manifestations included maculo-papular rashes (30%), unspecified rashes (25%), vesicular rashes (20%), erythema multiforme (10%), urticaria (10%) and erythema with desquamation (5%). Forty-one patients (29.9%) reported pruritus as the main symptom associated with chilblains, and 56 out of 137 patients also reported systemic symptoms such as respiratory symptoms (33.9%), fever (28%), intestinal (27%), headache (5.5%), asthenia (3.5%), and joint pain (2%). Associated comorbid conditions were observed in 9 patients presenting with skin lesions. Nasopharyngeal swabs turned out positive in 11 patients (8%), whereas the remainder were either negative (101, 73%) or unspecified (25, 18%).

CONCLUSIONS:

COVID-19 has been credited as the etiology of the recent increase in acro-ischemic lesions. The present study provides a description of pediatric cutaneous manifestations deemed to be potentially associated with COVID-19, revealing a possible association between acral cyanosis and nasopharyngeal swab positivity in children and teenagers. The identification and characterization of newly recognized patterns of skin involvement may aid physicians in diagnosing cases of asymptomatic or pauci-symptomatic COVID patients.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Chilblains / Exanthema / COVID-19 Type of study: Diagnostic study / Etiology study / Experimental Studies / Observational study / Prognostic study Topics: Long Covid Limits: Adolescent / Adult / Child / Child, preschool / Female / Humans / Infant / Male Country/Region as subject: Europa Language: English Journal: Ital J Dermatol Venerol Year: 2023 Document Type: Article Affiliation country: S2784-8671.23.07539-4

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Chilblains / Exanthema / COVID-19 Type of study: Diagnostic study / Etiology study / Experimental Studies / Observational study / Prognostic study Topics: Long Covid Limits: Adolescent / Adult / Child / Child, preschool / Female / Humans / Infant / Male Country/Region as subject: Europa Language: English Journal: Ital J Dermatol Venerol Year: 2023 Document Type: Article Affiliation country: S2784-8671.23.07539-4