key: cord-0964609-bp45671f
authors: Lesort, C.; Kanitakis, J.; Villani, A.; Ducroux, E.; Bouschon, P.; Fattouh, K.; Bensaid, B.; Danset, M.; Jullien, D.
title: COVID‐19 and outbreak of chilblains: are they related?
date: 2020-06-27
journal: J Eur Acad Dermatol Venereol
DOI: 10.1111/jdv.16779
sha: 21a145bc2418d62a29adc59e981d6ae4190fa9ff
doc_id: 964609
cord_uid: bp45671f

SARS‐CoV‐2 is a new coronavirus that causes COVID‐19, a disease associated with severe pneumonia.1 Many other clinical manifestations have been associated with the disease (diarrhoea, anosmia, dysgeusia, etc.) and patients can be healthy carriers of the virus.2 Several dermatologic manifestations associated with COVID‐19 have been reported.3 Among them are numerous cases of chilblain‐like lesions (CBLL) in young patients in good general condition, often not tested, or tested negative, for the SARS‐CoV‐2.4,5 In a recent study on 375 Spanish patients with suspected or confirmed COVID‐19, these CBLL accounted for 19% of all cutaneous lesions;3 they were observed in young patients with mild systemic symptoms and seemed to appear late in the course of the disease.

This article is protected by copyright. All rights reserved SARS-CoV-2 is a new coronavirus that causes COVID-19, a disease associated with severe pneumonia.1 Many other clinical manifestations have been associated with the disease (diarrhoea, anosmia, dysgeusia, etc.) and patients can be healthy carriers of the virus.2 Several dermatologic manifestations associated with COVID-19 have been reported.3 Among them are numerous cases of chilblain-like lesions (CBLL) in young patients in good general condition, often not tested, or tested negative, for the SARS-CoV-2.4,5 In a recent study on 375 Spanish patients with suspected or confirmed COVID-19, these CBLL accounted for 19% of all cutaneous lesions;3 they were observed in young patients with mild systemic symptoms and seemed to appear late in the course of the disease. Of note, CBLL are rarely observed in hospitalized patients;6 however, the causal association of these CBLL with SARS-CoV-2, although suspected, remains so far unproven.

We examined 45 outpatients referred to our department for CBLL, who were otherwise in good general condition. There were 26 men (58%) and 19 women (42%), of a mean age of 30.1 years.

Twelve patients (27%) mentioned nonspecific systemic symptoms preceding the onset of CBLL. an impaired IFN-type 1 activity associated with severe forms of COVID-19, and suggest that patients with type 1 IFN deficiency could be a high-risk population.7,8 The increased interferon score found in 40% of our patients tested may reflect a specific type of immune response, as has been reported in chilblain lupus and chilblains associated with interferonopathies, such as the Aicardi-Gouttières and SAVI syndromes.9,10 We speculate that this intense IFN response could help the patients to contain the replication of SARS-CoV-2, and would explain why they usually remain asymptomatic and merely develop CBLL . This hypothesis should be confirmed by later serologies of these patients, who could become seropositive long after the onset of symptoms.

In conclusion, our findings do not demonstrate a formal causal relationship between these CBLL and SARS-CoV-2; however, we advocate that patients with such skin lesions be systematically screened for SARS-CoV-2 infection. 

A Novel Coronavirus from Patients with Pneumonia in China

Alert for non-respiratory symptoms of Coronavirus Disease 2019 (COVID-19) patients in epidemic period: A case report of familial cluster with three asymptomatic COVID-19 patients

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

Chilblain acral lesions in the COVID-19 era. Are they marker of infection in asymptomatic patients?

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

Acral cutaneous lesions in the Time of COVID-19

Impaired type I interferon activity and exacerbated inflammatory responses in severe Covid-19 patients | medRxiv

Type I IFN immunoprofiling in COVID-19 patients

Aicardi-Goutières syndrome and the type I interferonopathies