自从COVID-19大流行开始以来,人们对这种疾病非常感兴趣,特别是其可能的临床表现。除了典型的呼吸道症状,皮肤病学表现经常发生在感染和未感染患者中,特别是在儿童中。显著的IFN-I应答,儿童通常比成人高,可能不仅会导致冻疮损伤,但它也可以预防感染和病毒复制,从而证明阴性拭子结果是合理的,以及在阳性病例中没有相关的全身症状。的确,已有报道描述已证实或疑似感染的儿童和青少年的冻疮样肢端病变.
年龄从1至18岁的患者被纳入来自23个意大利皮肤病学单位的这项研究,并观察了6个月的总体时间。收集临床图片以及皮肤病变的位置和持续时间的数据,它们与伴随的局部和全身症状有关,存在指甲和/或粘膜受累,以及组织学,实验室和影像学检查结果。
一百三十七个病人被包括在内,其中56.9%为女性。平均年龄为11.97±3.66岁。最常见的受影响部位是脚(77名患者,56.2%)。病变(48.5%)以紫癜为特征,冻疮,水泡,瘀斑,bullae,红斑,水肿,还有丘疹.伴随的皮肤表现包括黄斑丘疹(30%),未指定的皮疹(25%),泡状皮疹(20%),多形性红斑(10%),荨麻疹(10%)和脱屑红斑(5%)。41例患者(29.9%)报告瘙痒是与冻疮相关的主要症状,137名患者中有56名还报告了全身症状,如呼吸道症状(33.9%),发烧(28%),肠道(27%),头痛(5.5%),虚弱(3.5%),关节疼痛(2%)。在9例皮肤病变患者中观察到相关的合并症。11例患者(8%)鼻咽拭子呈阳性,而其余为阴性(101,73%)或未指定(25,18%)。
COVID-19被认为是最近关节缺血性病变增加的病因。本研究描述了被认为与COVID-19潜在相关的小儿皮肤表现,揭示了儿童和青少年的肢端紫癜与鼻咽拭子阳性之间可能存在关联。识别和表征新识别的皮肤受累模式可能有助于医生诊断无症状或无症状COVID患者的病例。
Since the COVID-19 pandemic started, great interest has been given to this disease, especially to its possible clinical presentations. Besides classical respiratory symptoms, dermatological manifestations occur quite often among infected and non-infected patients, particularly in children. A prominent IFN-I response, that is generally higher in children compared to adults, may not only cause chilblain lesions, but it could also prevent infection and viral replication, thus justifying the negative swab results, as well as the absence of relevant systemic symptoms in positive cases. Indeed, reports have emerged describing chilblain-like acral lesions in children and adolescents with either proven or suspected infection.
Patients aged from 1 to 18 years old were enrolled in this
study from 23 Italian dermatological units and were observed for an overall period of 6 months. Clinical pictures were collected along with data on the location and duration of skin lesions, their association with concomitant local and systemic symptoms, presence of nail and/or mucosal involvement, as well as histological, laboratory and imaging findings.
One hundred thirty-seven patients were included, of whom 56.9% were females. Mean age was 11.97±3.66 years. The most commonly affected sites were the feet (77 patients, 56.2%). Lesions (48.5%) featured
cyanosis, chilblains, blisters, ecchymosis, bullae, erythema, edema, and papules. Concomitant skin manifestations included maculo-papular rashes (30%), unspecified rashes (25%), vesicular rashes (20%), erythema multiforme (10%), urticaria (10%) and erythema with desquamation (5%). Forty-one patients (29.9%) reported pruritus as the main symptom associated with chilblains, and 56 out of 137 patients also reported systemic symptoms such as respiratory symptoms (33.9%), fever (28%), intestinal (27%), headache (5.5%), asthenia (3.5%), and joint pain (2%). Associated comorbid conditions were observed in 9 patients presenting with skin lesions. Nasopharyngeal swabs turned out positive in 11 patients (8%), whereas the remainder were either negative (101, 73%) or unspecified (25, 18%).
COVID-19 has been credited as the etiology of the recent increase in acro-ischemic lesions. The present
study provides a description of pediatric cutaneous manifestations deemed to be potentially associated with COVID-19, revealing a possible association between acral
cyanosis and nasopharyngeal swab positivity in children and teenagers. The identification and characterization of newly recognized patterns of skin involvement may aid physicians in diagnosing cases of asymptomatic or pauci-symptomatic COVID patients.