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New Covid-19 symptom: Chilblains on children’s hands and feet

After one Italian study analyzed cases of injury on the hands and feet of children, experts have no doubt that it is "a late manifestation of the virus".

Published: April 21, 2020, 7:27 am

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    To date, a dry cough, high fever and breathing difficulties have been the distinctive symptoms of Covid-19 but, from careful clinical observation, the hypothesis of chilblains on hands and feet have also been added.

    Those affected are mainly children and adolescents, that is, the lowest percentage of those infected in the epidemic with estimates ranging between 5 percent and 18 percent of the world population.

    The observation was born following a long series of reports concerning pediatric patients received by doctors involved in fighting the Coronavirus. At the moment, the possibility of a close link between these skin excoriations and the much more known manifestations of the infection cannot be excluded.

    “Children and young adults with red and purple lesions in particular on the ends of the toes and hands have been in the clinic for several weeks,” said Sebastiano Recalcati, dermatologist at the Lecco hospital.

    He spoke to Italian daily Corriere della Sera. “Chilblains are already rare, but now is not even the season. We also did serological tests to investigate the presence of other viruses, but they were negative. We think that these lesions similar to chilblains can be a late manifestation of the disease.”

    Similar confirmations also come from Andrea Locatelli, dermatologist to Pope Giovanni XXIII: “We are seeing particular manifestations especially in adolescents and children, who look like chilblains but which can hardly be because they are not in line with the season.”

    To date, it has been difficult to ascertain unequivocally the link between the disease and this kind of skin manifestation, however, logic suggests an evident deduction.

    “The children and teenagers we saw were doing well, although some had had a little cough three weeks earlier, while others may have had close contact with the virus because they were the children of health workers, still others had simply come for a visit without ever showing the slightest symptom. On some of them we performed the swab, which was always negative.”

    Specifically, these could be late symptoms, that is, the posthumous onset of the infection. “We think that chilblains can be a late manifestation of the virus, even a month after the infection, so the swabs are negative,” explained the dermatologist.

    “We suspect that the more active immune system of children would favor this immune-mediated manifestation. The keystone will be the serological test: if there is immunological memory you will know. Certainly it is a fact and it is strange that there are reports from all over the world, from Dubai to Argentina, of chilblains among children and adolescents.”

    Chilblains sometimes accompany itching and evolve within two to three weeks towards self-resolution. If the itching persists, an antihistamine is prescribed.

    A study on skin manifestations attributable to Covid-19, signed by Dr. Sebastiano Recalcati, has already been published in the Journal of European Academy of Dermatology and Venereology.

    “I visited and reviewed the data of the patients who entered our hospital and I found that in people with Covid-19 skin manifestations were present in about 20 percent of cases,” explained the dermatologist

    Such skin ailments must be distinguished from drug reactions that can occur in these patients undergoing numerous therapies. Recalcati said at the cutaneous level, as happens at the lung level, an activation of the inflammatory cascade eventually targets the skin’s vessels.

    In light of clinical investigations, some dermatologists have asked for a national registry of chilblake-like injuries to the lower limbs with a letter addressed to the Ministry of Health.

    “Starting from the end of last March, one month after the first ascertained case of Covid-19, reports, especially by pediatricians from all over Italy, of injuries of this type in asymptomatic children (some post para-influenza syndrome, others with a Covid-19 positive parent, many others without obvious links with viraemia) have reached massive dimensions.”

    Similar reports also come from France and Spain. Recalcati added that if this correlation were to be shown, it is most most likely because the children had a mild form of this disease weeks before and at the time of the skin manifestations they are no longer contagious.

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