- Although there is evolving evidence suggesting that skin manifestations may occur in some COVID-19 patients, experts are not unanimous. Current data do not allow a clear link between pernio-like lesions and COVID-19. However, due to an increased number of cases in young patients during the pandemic and until the physiopathology is better understood, new onset of pernio-like lesions, in the absence of any other clear cause, should be considered potentially related to COVID-19.
- A prompt discussion between patient and their physician may include:
- A case-by-case discussion of appropriateness of self-isolation following local guidelines.
- A case-by-case discussion of COVID-19 testing by PCR and/or IgM and IgG serology (when available), following local testing guidelines, in order to evaluate the hypothesis of this lesion being a late or post-infectious manifestation of the infection.
- . The Canadian Paediatric Surveillance Program suggest to:
- test any patients who present with unusual cutaneous manifestations such as acrocyanosis, pernio-like changes and acral ischemia.
- initiate 14-day isolation periods for patients and family members, if indicated
- Patients presenting with pernio-like lesions do not generally require a specific dermatologic management:
- Unprotected exposure to cold should be avoided.
- Topical corticosteroids and acetaminophen can be recommended in some cases.
- Dermatology consultation should be considered in the presence of severe or atypical lesions.
- A careful consideration of not overburdening local emergency room resources should be kept in mind while managing patients presenting with pernio without other COVID-19 indications for urgent evaluation.
These statements come from updated documents on cutaneous manifestations and COVID-19, produced by INESSS (Québec), the Canadian Paediatric Surveillance Program and the American Association of Dermatology.
- American Academy of Dermatology. (May 7, 2020) Statement on Dermatologic Manifestations of COVID-19 Retrieved from https://www.aad.org/member/practice/coronavirus/clinical-guidance/dermatological-manifestations-covid-19
- Canadian Paediatric Surveillance Program. (2020) COVID-19 and Skin Changes in Children. Retrieved from https://www.cpsp.cps.ca/
- INESSS . (May 12, 2020) COVID-19 : manifestations cutanées (lésions de type perniose, lésions associées à des dommages vasculaires et autres types de lésions) Retrieved from https://www.inesss.qc.ca/covid-19/presentations-cliniques/manifestations-cutanees.html