Acral Lesions: What We Know

459 views 1 05/05/2020 05/08/2020

1. Initial reports of acute acro-ischemic lesions in children were published by Mazzotta F. and Trocolli T.

2. Terms used include acral lesions, acro-ischemic lesions, perniosis, pernio or chilblain (also -like or pseudo-).

3. Acral lesions are often reported in children and young adults.

  • Median age: 19,9 years old (Fernandez-Nieto D. et al.), 14 years old (Piccolo V. et al.), 30 years old (Société Française de Dermatologie).

4. Fernandez-Nieto D. et al reported 132 patients with acral skin lesions and described two patterns:  chilblain-like (95) and erythema multiforme-like (37).

  • Feet involvement is more frequent followed by feet and hands and hands alone (Piccolo V. et al. and Casas C.G. et al.).
  • Lesions are either erythematous, violaceous oedematous or blistering (Piccolo V. et al. andCasas C.G. et al.). Chilblain-like lesions affect the toes.
  • They were either asymptomatic, painful and/or itchy (Piccolo V. et al. and Casas C. G. et al.)

5. Acral lesions occur days after mild infectious symptoms if any.  Casas C.G. et al. reported that it is alate onset manifestation and that it appears to be associated with a less severe presentation.

6. Acral lesions are self-resolving (8-12 days).

7. Acral lesions are probably related to vascular damage:

  • Bouaziz J.D. et al. put forward 3 hypotheses on the etiology of these lesions: 1) that they are not related to COVID-19 2) that they are related to a post viral immunological reaction 3) that they are a manifestation of COVID-19 in a subgroup of patients with a different anti-viral response.
  • Piccolo V. et al. hypothesizes that this skin manifestation could be related to a delayed immune response to the virus in geneticaly-predisposed patients. However, it is too early to conclude that this is a manifestation of COVID-19.

8. More studies are required to assess a link between cutaneous lesions and COVID-19.  INESSS will be following any new publications on the matter.

9.  Idiopathic perniosis traditionally seen in cooler, damp climates may still occur.

 

 

Sources :

  1. American Academy of Dermatology. (April 22, 2020). THE PROFOUND DERMATOLOGICAL MANIFESTATIONS OF COVID-19: PART IV – CUTANEOUS FEATURES. Retrieved from: https://www.aad.org/dw/dw-insights-and-inquiries/2020-archive/april/dermatological-manifestations-covid-19-part-4
  2. American Academy of Dermatology. (May 7, 2020). Statement on Dermatologic Manifestations of COVID-19. Retrieved from: https://assets.ctfassets.net/1ny4yoiyrqia/3yRy6nJxNnxjT07K1xelJW/379f44cfd70f92c2fb0df05620b44f53/AAD_Statement_on_Dermatologic_Manifestations_of_COVID-19_EF_updated.pdf
  3. Bouaziz J. D., Duong T., Jachiet M. et al. (April 17, 2020). Vascular skin symptoms in COVID-19: A french observational study. Journal of the European Academy of Dermatology and Venereology: JEADV. https://doi.org/10.1111/jdv.16544
  4. Casas C. G., Català A., Hernández G. C., et al (April 19, 2020) Classification of the cutaneous manifestations of COVID-19: A rapid prospective nationwide consensus study in Spain with 375 cases. British Journal of Dermatology. https://doi.org/10.1111/bjd.19163
  5. Fernandez-Nieto D., Jimenez-Cauhe J., Suarez-Valle A., et al. (April 21, 2020). Characterization of acute acro-ischemic lesions in non-hospitalized patients: A case series of 132 patients during the COVID-19 outbreak. Journal of the American Academy of Dermatology. https://doi.org/10.1016/j.jaad.2020.04.093
  6. Institut national d’excellence en santé et en services sociaux (INESSS). (April 22, 2020) COVID-19 et manifestations cutanées. Retrieved from https://www.inesss.qc.ca/covid-19/presentations-cliniques/manifestations-cutanees.html
  7. Mazzotta F., Troccoli T. (March 2020). ACUTE ACRO-ISCHEMIA IN THE CHILD AT THE TIME OF COVID-19. Dermatologia Pediatrica. https://img.beteve.cat/wp-content/uploads/2020/04/acroischemia-ENG.pdf
  8. Piccolo V., Neri I., Filippeschi C. et al. (April 24, 2020) Chilblain-like lesions during COVID-19 epidemic: A preliminary study on 63 patients. Journal of the European Academy of Dermatology and Venereology, n/a(n/a). https://doi.org/10.1111/jdv.16526
  9. Société Française de Dermatologie (April 28, 2020). COVID-19 ET LÉSIONS CUTANÉES POINT D’ÉTAPE 2 DE L’ENQUÊTE COVIDSKIN DE LA SOCIÉTÉ FRANÇAISE DE DERMATOLOGIE Retrieved from:https://evenements-sfd.fr/wp-content/uploads/2020/04/point-etape-covidskin-27-04-20.pdf?utm_source=mailpoet&utm_medium=email&utm_campaign=actualites-du-fonds-de-dotation-de-la-sfd_171 
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