key: cord-340283-5w444i1g
authors: Das, Anupam; Singh, Vinay
title: Erythematous‐oedematous type of chilblain‐like lesions and COVID‐19 : an Indian perspective
date: 2020-06-27
journal: Dermatol Ther
DOI: 10.1111/dth.13912
sha: 
doc_id: 340283
cord_uid: 5w444i1g

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The burning and tingling sensation could not be attributed to any other systemic or cutaneous etiology. Although two patients (age 52 and 32 years) were diabetic, they did not have any such complaints prior to the diagnosis of COVID-19. Pure neuritic leprosy was excluded in our patients on the basis of time of onset of the lesions, non-specific findings on nerve conduction velocity and resolution of the symptoms following recovery from the disease. One of our patients presented with symptoms of "erythromelalgia", and this could be attributed to microvascular thrombotic injury. Complement associated microvascular injury and thrombosis have been already implicated in the pathophysiology of severe COVID-19 infection, and the development of "erythromelalgia" like symptoms could be attributed to a similar mechanism. Therefore, the temporal association, complaints of the peculiar neurological sensation followed by development of erythema and swelling in our patients, supports the probable association of the cutaneous manifestations, with COVID-19. The patients had been advised symptomatic treatment, and the signs and symptoms disappeared following recovery from the disease.

In a recent study published by Recalcati et al. from Italy; commonest signs were erythematous rash (77.8%) followed by urticaria (16.7%) and vesiculation (5.6%). 2 Other skin changes that have been reported include dusky acrocyanosis and dry gangrene from China; 3 chicken-pox like rash from Italy, 2 transient unilateral livedo reticularis from United States, 4 dengue-like rash from Thailand, 5 plaques in the heels from Spain. 6 In one of the largest series published from Spain, cutaneous manifestations were pseudochilblains (19%), vesicular eruptions (9%), urticaria (19%), maculopapular rashes (47%) and livedo (6%). 7 In the Spanish series, 19% of the cases were classified as "pseudochilblains", characterized by presence of asymmetrical areas of erythema and oedema, over the hands and feet. 7 In another series published from Italy, authors noticed an outbreak of chilblain-like lesions in Italy contemporary to COVID-19 epidemic, who reported two varieties of lesions, namely erythematous-oedematous type and blistering type. 8 

Cutaneous manifestations in COVID-19: a first perspective

A dermatologic manifestation of COVID-19: transient livedo reticularis

COVID-19 can present with a rash and be mistaken for dengue

Cutaneous manifestations in COVID-19: a new contribution

Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases

Chilblain-like lesions during COVID-19 epidemic: a preliminary study on 63 patients

Chilblain-like lesions on feet and hands during the COVID-19 Pandemic

Absence of Skin of Colour Images in Publications of COVID-19 Skin Manifestations

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