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Pernio-like skin lesions associated with COVID-19: A case series of 318 patients from 8 countries - 23/07/20

Doi : 10.1016/j.jaad.2020.05.109 
Esther E. Freeman, MD, PhD a, b, , Devon E. McMahon, BA a, Jules B. Lipoff, MD c, Misha Rosenbach, MD c, Carrie Kovarik, MD c, Junko Takeshita, MD, PhD, MSCE c, Lars E. French, MD d, Bruce H. Thiers, MD e, George J. Hruza, MD, MBA f, Lindy P. Fox, MD g
for the

American Academy of Dermatology Ad Hoc Task Force on COVID-19

a Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 
b Medical Practice Evaluation Center, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts 
c Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania 
d Department of Dermatology, University Hospital, Munich University of Ludwig Maximilian, Munich, Germany 
e Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina 
f Department of Dermatology, St. Louis University, St Louis, Missouri 
g Department of Dermatology, University of California, San Francisco, California 

Correspondence to: Esther Freeman, MD, PhD, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114.Massachusetts General Hospital55 Fruit StBostonMA02114

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Abstract

Background

Increasing evidence suggests pernio-like lesions are cutaneous manifestations of coronavirus infectious disease 2019 (COVID-19).

Objective

To describe clinical and pathologic findings of pernio-like lesions in patients with confirmed or suspected COVID-19.

Methods

An international dermatology registry was circulated to health care providers worldwide through the American Academy of Dermatology, International League of Dermatologic Societies, and other organizations.

Results

We documented 505 patients with dermatologic manifestations associated with COVID-19, including 318 (63%) with pernio-like lesions. Patients with pernio-like lesions were generally young and healthy, with relatively mild COVID-19. Of 318 patients with confirmed or suspected COVID-19 by providers, 23 (7%) were laboratory-confirmed COVID-19 positive, and 20 others (6%) were close contacts of patients with confirmed COVID-19. Given current testing criteria, many patients lacked COVID-19 testing access. For 55% of patients, pernio-like lesions were their only symptom. In patients with other COVID-19 symptoms, pernio-like lesions typically appeared after other symptoms. Pernio-like lesions lasted a median of 14 days (interquartile range, 10-21 days).

Limitations

A case series cannot estimate population-level incidence or prevalence. In addition, there may be confirmation bias in reporting. We cannot exclude an epiphenomenon.

Conclusions

Pernio-like skin changes of the feet and hands, without another explanation, may suggest COVID-19 infection and should prompt confirmatory testing.

Le texte complet de cet article est disponible en PDF.

Key words : chilblains, COVID-19, dermatology, pernio, public health

Abbreviations used : COVID-19, Ig, PCR, SARS-CoV-2


Plan


 Funding sources: None.
 Conflicts of interest: Drs Freeman, Lipoff, Rosenbach, Kovarik, Takeshita, Hruza, and Fox are part of the American Academy of Dermatology (AAD) Covid-19 Ad Hoc Task Force. Dr French is president of the International League of Dermatological Societies. Dr Hruza is immediate past president of the AAD. Dr Thiers is the president of the AAD. Author McMahon has no conflicts of interest to disclose.
 IRB approval status: The registry was reviewed by the Partners Healthcare (Massachusetts General Hospital) Institutional Review Board and was determined to not meet the definition of Human Subjects Research.
 Reprints not available from the authors.


© 2020  American Academy of Dermatology, Inc.. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 83 - N° 2

P. 486-492 - août 2020 Retour au numéro
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