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Chilblain-like lesions on feet and hands during the COVID-19 Pandemic

Our take —

Physicians should keep an eye out for chilblain-like lesions on toes and fingers, as these may be a late presentation of COVID-19, or may help with diagnosis of COVID-19 in otherwise asymptomatic persons. Persons presenting with these skin-like lesions should be asked about previous symptoms and exposure history, and should be recommended to adhere to general preventive measures, including social distancing and hand hygiene.

Study design

Case Series

Study population and setting

A case series of 6 patients with dermatologic (chilblain-like) manifestations suspected due to COVID-19. The cases were reported to a group of dermatologists providing application-based home care to urgent dermatologic cases in Spain.

Summary of Main Findings

Six patients (ages 15, 15, 23, 24, 33, 44 and 91 years) presented with mildly painful and sometimes itchy skin lesions found mainly on the toes, heels, soles of feet, and fingers. One patient without known contact to COVID-19 presented with mild bilateral pneumonia but was otherwise asymptomatic and tested negative on polymerase chain reaction (PCR) and antibody tests for COVID-19. Three patients (one with known exposure to COVID-19 and one from a high-risk area) showed mild symptoms, such as nasal congestion, diarrhea, fever, headache, and sore throat in the 1-3 weeks prior to appearance of the skin lesions, but were not tested for COVID-19. Two patients, including the 91 year-old who required hospitalization, tested positive for COVID-19 prior to the arrival of skin lesions.

Study Strengths

Detailed description with images of potentially novel presentation of COVID-19.

Limitations

Heterogenous presentation with only 2 confirmed COVID-19 cases. The lesions were not biopsied. Small sample size.

Value added

First (known) coverage of a series of patients with chilblain-like skin lesions on feet (mainly toes) following potential exposure to or known COVID-19 infection.