Most chilblains observed during the COVID-19 outbreak occur in patients who are negative for COVID-19 on polymerase chain reaction and serology testing.
Adolescent
Adult
Betacoronavirus
/ genetics
Biopsy
COVID-19
COVID-19 Testing
Chilblains
/ blood
Clinical Laboratory Techniques
Coronavirus Infections
/ complications
Female
France
/ epidemiology
Humans
Male
Pandemics
Pneumonia, Viral
/ complications
Polymerase Chain Reaction
RNA, Viral
/ isolation & purification
SARS-CoV-2
Serologic Tests
Skin
/ pathology
Young Adult
Journal
The British journal of dermatology
ISSN: 1365-2133
Titre abrégé: Br J Dermatol
Pays: England
ID NLM: 0004041
Informations de publication
Date de publication:
11 2020
11 2020
Historique:
accepted:
26
06
2020
pubmed:
7
7
2020
medline:
18
11
2020
entrez:
7
7
2020
Statut:
ppublish
Résumé
Acral lesions, mainly chilblains, are the most frequently reported cutaneous lesions associated with COVID-19. In more than 80% of patients tested, nasopharyngeal swabs were negative on reverse transcription polymerase chain reaction (RT-PCR) for SARS-CoV-2 when performed, and serology was generally not performed. A national survey was launched on 30 March 2020 by the French Society of Dermatology asking physicians to report cases of skin manifestations in patients with suspected or confirmed COVID-19 by using a standardized questionnaire. We report the results for acral manifestations. We collected 311 cases of acral manifestations [58.5% women, median age 25.7 years (range 18-39)]. The most frequent clinical presentation (65%) was typical chilblains. In total, 93 cases (30%) showed clinical suspicion of COVID-19, 67 (22%) had only less specific infectious symptoms and 151 (49%) had no clinical signs preceding or during the course of acral lesions. Histology of skin biopsies was consistent with chilblains. Overall, 12 patients showed significant immunological abnormalities. Of the 150 (48%) patients who were tested, 10 patients were positive. Seven of 121 (6%) RT-PCR-tested patients were positive for SARS-CoV-2, and five of 75 (7%) serology-tested patients had IgG anti-SARS-CoV-2. Tested/untested patients or those with/without confirmed COVID-19 did not differ in age, sex, history or acral lesion clinical characteristics. The results of this survey do not rule out that SARS-CoV-2 could be directly responsible for some cases of chilblains, but we found no evidence of SARS-CoV-2 infection in the large majority of patients with acral lesions during the COVID-19 lockdown period in France. What is already known about this topic? About 1000 cases of acral lesions, mainly chilblains, were reported during the COVID-19 outbreak. Chilblains were reported to occur in young people within 2 weeks of infectious signs, which were mild when present. Most cases did not have COVID-19 confirmed by reverse transcription polymerase chain reaction (RT-PCR), and few serology results were available. What does this study add? Among 311 patients with acral lesions, mainly chilblains, during the COVID-19 lockdown period in France, the majority of patients tested had no evidence of SARS-CoV-2 infection. Overall, 70 of 75 patients were seronegative for SARS-Cov-2 serology and 114 of 121 patients were negative for SARS-CoV-2 RT-PCR.
Sections du résumé
BACKGROUND
Acral lesions, mainly chilblains, are the most frequently reported cutaneous lesions associated with COVID-19. In more than 80% of patients tested, nasopharyngeal swabs were negative on reverse transcription polymerase chain reaction (RT-PCR) for SARS-CoV-2 when performed, and serology was generally not performed.
METHODS
A national survey was launched on 30 March 2020 by the French Society of Dermatology asking physicians to report cases of skin manifestations in patients with suspected or confirmed COVID-19 by using a standardized questionnaire. We report the results for acral manifestations.
RESULTS
We collected 311 cases of acral manifestations [58.5% women, median age 25.7 years (range 18-39)]. The most frequent clinical presentation (65%) was typical chilblains. In total, 93 cases (30%) showed clinical suspicion of COVID-19, 67 (22%) had only less specific infectious symptoms and 151 (49%) had no clinical signs preceding or during the course of acral lesions. Histology of skin biopsies was consistent with chilblains. Overall, 12 patients showed significant immunological abnormalities. Of the 150 (48%) patients who were tested, 10 patients were positive. Seven of 121 (6%) RT-PCR-tested patients were positive for SARS-CoV-2, and five of 75 (7%) serology-tested patients had IgG anti-SARS-CoV-2. Tested/untested patients or those with/without confirmed COVID-19 did not differ in age, sex, history or acral lesion clinical characteristics.
CONCLUSIONS
The results of this survey do not rule out that SARS-CoV-2 could be directly responsible for some cases of chilblains, but we found no evidence of SARS-CoV-2 infection in the large majority of patients with acral lesions during the COVID-19 lockdown period in France. What is already known about this topic? About 1000 cases of acral lesions, mainly chilblains, were reported during the COVID-19 outbreak. Chilblains were reported to occur in young people within 2 weeks of infectious signs, which were mild when present. Most cases did not have COVID-19 confirmed by reverse transcription polymerase chain reaction (RT-PCR), and few serology results were available. What does this study add? Among 311 patients with acral lesions, mainly chilblains, during the COVID-19 lockdown period in France, the majority of patients tested had no evidence of SARS-CoV-2 infection. Overall, 70 of 75 patients were seronegative for SARS-Cov-2 serology and 114 of 121 patients were negative for SARS-CoV-2 RT-PCR.
Identifiants
pubmed: 32628270
doi: 10.1111/bjd.19377
pmc: PMC7361395
doi:
Substances chimiques
RNA, Viral
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
866-874Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2020 British Association of Dermatologists.
Références
J Clin Virol. 2020 Jun;127:104346
pubmed: 32361324
BMJ. 2020 May 12;369:m1808
pubmed: 32398230
J Am Acad Dermatol. 2020 Jul;83(1):e61-e63
pubmed: 32339703
J Am Acad Dermatol. 2001 Dec;45(6):924-9
pubmed: 11712041
Lancet Haematol. 2020 Jun;7(6):e438-e440
pubmed: 32407672
Dermatol Ther. 2020 Jul;33(4):e13617
pubmed: 32424886
Actas Dermosifiliogr (Engl Ed). 2020 Jun;111(5):426-429
pubmed: 32402369
Clin Exp Dermatol. 2020 Oct;45(7):891-892
pubmed: 32369632
Zhonghua Xue Ye Xue Za Zhi. 2020 Apr 14;41(4):302-307
pubmed: 32447934
Br J Dermatol. 2020 Jul;183(1):71-77
pubmed: 32348545
J Eur Acad Dermatol Venereol. 2020 Jul;34(7):e299-e300
pubmed: 32314436
J Am Acad Dermatol. 2020 Aug;83(2):687-690
pubmed: 32422225
J Eur Acad Dermatol Venereol. 2020 May;34(5):e212-e213
pubmed: 32215952
J Eur Acad Dermatol Venereol. 2020 Jul;34(7):e291-e293
pubmed: 32330334
N Engl J Med. 2020 Apr 30;382(18):1708-1720
pubmed: 32109013
Dermatol Ther. 2020 Sep;33(5):e13516
pubmed: 32378284
J Clin Virol. 2020 Aug;129:104468
pubmed: 32485620
Lancet. 2020 Mar 28;395(10229):1054-1062
pubmed: 32171076
J Clin Microbiol. 2020 Jul 23;58(8):
pubmed: 32381641
Clin Exp Dermatol. 2012 Dec;37(8):844-9
pubmed: 23082992
J Am Acad Dermatol. 2020 Aug;83(2):667-670
pubmed: 32380219
J Eur Acad Dermatol Venereol. 2020 Sep;34(9):e449-e450
pubmed: 32441830
J Eur Acad Dermatol Venereol. 2020 Nov;34(11):2620-2629
pubmed: 32474947
Clin Exp Dermatol. 2020 Dec;45(8):1065-1067
pubmed: 32421857
J Am Acad Dermatol. 2020 Aug;83(2):486-492
pubmed: 32479979
An Bras Dermatol. 2014 Jan-Feb;89(1):44-50
pubmed: 24626647
J Am Acad Dermatol. 2020 Sep;83(3):870-875
pubmed: 32502585
Pediatr Dermatol. 2020 May;37(3):406-411
pubmed: 32386460
J Eur Acad Dermatol Venereol. 2020 Aug;34(8):e373-e375
pubmed: 32386446
J Eur Acad Dermatol Venereol. 2020 Aug;34(8):e346-e347
pubmed: 32330324