key: cord-0771134-h7kihj9w
authors: Piccolo, Vincenzo; Bassi, Andrea
title: Acral findings during the COVID-19 outbreak: Chilblain-like lesions should be preferred to acro-ischemic lesions
date: 2020-05-22
journal: J Am Acad Dermatol
DOI: 10.1016/j.jaad.2020.05.077
sha: 74ca244e23dd719d7b557f11d88f57821acbd454
doc_id: 771134
cord_uid: h7kihj9w

nan

We read with great interest the recent paper by Fernandez-Nieto et al published in JAAD 1 . The authors report a case series of 132 patients with acute acro-ischemic lesions affecting nonhospitalized patients during the COVID-19 outbreak. The same cutaneous findings have been described all over the world, including a preliminary study conducted by ourselves 2 .

In their paper, Fernandez-Nieto et al repeatedly use the appellative "acro-ischemic" for this cutaneous manifestation. Moreover, they hypothesize a relationship between a COVID-19-related altered coagulation profile and these acral lesions. As the authors state, true ischemic lesions have been reported in severely-ill patients with proven coronavirus infection 3 .

Although the comparison between acral lesions in asymptomatic patients and ischemic lesions in severe cases is important, we find the term "acute acro-ischemic lesions" not accurate. Patients present with painful or itchy erythematous-edematous lesions of the extremities, sometimes evolving to blistering. This presentation is similar to what it is commonly seen in chilblains. The word "chilblains" itself etymologically refers to cold exposure (chill = cold, blain = sore). The term chilblain-like lesions, in our opinion, therefore would be preferable for the lesions that present in these patients rather than acro-ischemic lesions. In addition, histopathology of these lesions is quite similar to chilblains, with an absence of true necrosis; this is different to what it is typically found in hospitalized patients 4 .

Although the exact pathogenesis of this cutaneous sign is not known yet, a worldwide common nomenclature would in our opinion be a good starting point in order to avoid confusion among clinicians.

Characterization of acute acroischemic lesions in non-hospitalized patients: a case series of 132 patients during the COVID-19 outbreak

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

COVID-19) infectioninduced chilblains: a case report with histopathological findings