key: cord-0879445-d10s0ghe
authors: Navarro, Lourdes; Andina, David; Noguera‐Morel, Lucero; Hernández‐Martín, Angela; Colmenero, Isabel; Torrelo, Antonio
title: Dermoscopy features of COVID‐19‐related chilblains in children and adolescents
date: 2020-07-02
journal: J Eur Acad Dermatol Venereol
DOI: 10.1111/jdv.16800
sha: 692644bcd0ea8462dda3878ebdd1fbaf5f889d4f
doc_id: 879445
cord_uid: d10s0ghe

Chilblains are skin condition frequently seen by physicians worldwide during the COVID‐19 outbreak. We attended 22 children and adolescents with chilblains during the outbreak peak of COVID‐19 in Madrid. The clinicopathologic and laboratory features of these patients have been reported. We describe herein the dermoscopic findings. Approval from the institutional Ethics Committee and Board was obtained. Standard informed consents were obtained for recording images in all patients.

images in all patients.

We analyzed 41 dermoscopy pictures obtained from different skin lesions in 12 patients with chilblains. The patients presented erythematous to purpuric macules and violaceous swellings located on the toes and feet. The images corresponded to lesions located on the perionychium (17), tip of toe with or without subungual (13), dorsum or side of toe (7), dorsum of foot (2) , ankle (1) and only subungual (1) ( Table 1) .

Three main dermoscopic features were observed: a background area, globules and reticule ( Figure) . The background area is the predominant background color in the lesion, ranging from red, purple and brown to grey. Globules are round to oval structures of red to purple color. And the network reticule is a mesh of grey-brown interconnected lines usually located peripherally within the background macule.

The background area was present in all cases; the predominant color was red in 18 pictures, brown in 11, purple in 10 and grey in 2. Most pictures (31) contained areas of other colors within the areas whereas in 10 (24.4 %) there was only one homogeneous color present. Globules were seen in 38 images (92.7 %), and were prominent in 32 and mild in 6. The globules were included within the background area in most cases, but in some they were seen outside the macules on a background of normal-looking skin. A reticule was observed in 12 images (29.3 %). Other features found were splinter hemorrhages in the nails (3 images), dilated capillaries in the nail folds with loss of polarity (2 images), and subcorneal hemorrhagic dots (1 images).

Dermoscopy mirrors the clinical and histopathologic features of COVID-19-related chilblains. 1 The background color is an indicator of vascular macules, and variations found in the pictures analyzed probably reflect the evolution of lesions, being mostly red in early phases from vascular dilatation, purple later from extensive red cell extravasation and finally brown as a consequence of hemosiderin deposition. Grey areas may be indicative of more intense ischemic phenomena.

This article is protected by copyright. All rights reserved The specificity of the features found is uncertain because no dermoscopic study of primary chilblains or chilblains secondary to other causes has been published. Dermoscopy studies in purpuric lesions highlight that the background color is related with the inflammatory infiltrate, hemosiderin deposition, and vascular dilatation. 3, 4 Red globules represent extravasated red cells, and the grey-brown reticule is possibly due to pigment incontinence, lichenoid infiltrates along with vascular changes. 5 We conclude that dermoscopy may be a useful aid for the diagnosis of chilblains in the setting of COVID-19 infection. 

Chilblains Accepted Article This article is protected by copyright. All rights reserved in children in the setting of COVID-19 pandemic

A clinical, histopathological and laboratory study of 19 consecutive Italian paediatric patients with chilblain-like lesions: lights and shadows on the relationship with COVID-19 infection

Dermoscopy of pigmented purpuric dermatoses (lichen aureus): a useful tool for clinical diagnosis

Dermoscopic patterns of purpuric lesions

Vascular patterns in dermoscopy

This article is protected by copyright. All rights reserved

Lesion Background area Globules Reticule