Kanitakis J, Lesort C, Danset M, Jullien D, et al.
Journal of the American Academy of Dermatology. Date of publication 2020 Sep 1;volume 83(3):870-875.
1. J Am Acad Dermatol. 2020 Sep;83(3):870-875. doi: 10.1016/j.jaad.2020.05.145. Epub
2020 Jun 2.
Chilblain-like acral lesions during the COVID-19 pandemic ("COVID toes"):
Histologic, immunofluorescence, and immunohistochemical study of 17 cases.
Kanitakis J(1), Lesort C(2), Danset M(2), Jullien D(2).
Author information:
(1)Department of Dermatology, Edouard Herriot Hospital, Hospices Civils de Lyon,
Lyon, France; Department of Anatomic Pathology, Lyon Sud Hospital Center, Pierre
Bénite, France. Electronic address: jean.kanitakis@univ-lyon1.fr.
(2)Department of Dermatology, Edouard Herriot Hospital, Hospices Civils de Lyon,
Lyon, France.
BACKGROUND: During the coronavirus disease 2019 pandemic, several acral
chilblain-like lesions were observed in young patients with suspected, but mostly
unconfirmed, infection with severe acute respiratory syndrome coronavirus 2. The
histopathologic aspect of these lesions is as yet poorly known.
OBJECTIVE: To investigate the pathologic features of chilblain-like lesions.
METHODS: Biopsies were obtained from 17 cases of chilblain-like lesions during
the coronavirus disease 2019 pandemic in France and were studied by routine
histologic examination, immunohistochemistry, and direct immunofluorescence. The
patients had suspected but unconfirmed infection with severe acute respiratory
syndrome coronavirus 2 (negative nasopharyngeal polymerase chain reaction and
serologic test results).
RESULTS: Chilblain-like lesions showed many features in common with those
reported in idiopathic and autoimmune-related chilblains, including epidermal
necrotic keratinocytes, dermal edema, perivascular and perieccrine sweat gland
lymphocytic (predominantly CD3/CD4+) inflammation, and frequent vascular changes
(endothelialitis, microthromboses, fibrin deposition, and immunoreactant deposits
on vessels).
CONCLUSIONS: Chilblain-like lesions show histopathologic features similar to
those of idiopathic and autoimmune-related chilblains, with a high rate of
vascular changes and direct immunofluorescence positivity. The role of severe
acute respiratory syndrome coronavirus 2 in the development of these puzzling
lesions remains to be elucidated.
Copyright © 2020 American Academy of Dermatology, Inc. Published by Elsevier Inc.
All rights reserved.
DOI: 10.1016/j.jaad.2020.05.145
PMCID: PMC7265862
PMID: 32502585 [Indexed for MEDLINE]
