Figure - available from: Dermatologic Therapy
This content is subject to copyright. Terms and conditions apply.
(A) Different background colors ranging from dull red (black circle) to orange‐brown (blue square), inset showing violaceous macules over great toes. (Dermlite DL200 hybrid, 10× magnification). (B) Variable background color with brown/black dots and clods (black arrows), inset showing subsiding clinical lesions. (C) Diffuse coiled vessels (black circle) and dot vessels (blue circle) over an orange‐brown (black square) background and orange‐red structureless areas (star). Inset showing multiple erythematous to violaceous papules and nodules over feet. (D) White dots/clods (black arrow) and lines (blue arrow) and orange‐red structureless areas (blue star) over a violaceous background (black start) seen in lesions over palms and soles (inset)
Source publication
Perniosis/ chilblains are the acral inflammatory skin lesions developing in susceptible individuals as an abnormal reaction to cold. In the absence of a discernible cause, it is labeled as idiopathic perniosis (IP). With the ongoing COVID‐19 pandemic, there was an upsurge of reports of chilblain like lesions (CLL) especially in young patients possi...
Citations
... It can be idiopathic, hereditary, or associated with diseases such as leukemia, viral infections, and rheumatoid arthritis. The perniosis-like lesions observed in COVID-19 cases are clinically and histopathologically similar to perniosis, except for the definition of its triggering by cold (26) . ...
Introdução: Objetivou-se revisar a literatura sobre sinais e sintomas ocasionados ou exacerbados pela COVID-19 em pé e tornozelo. Métodos: Trata-se de uma revisão integrativa da literatura. Foram selecionados artigos das plataformas Scielo e PubMed, publicados entre dezembro de 2020 e 2023, obtidos pela combinação dos descritores “COVID-19”, “Sinais e Sintomas”, "Articulações”, “Pé” e “Tornozelo”, que respondiam à pergunta norteadora: “Quais os sinais em pés e tornozelos apresentados por pacientes acometidos pela COVID-19?”. Resultados: Foram incluídos 21 artigos, e deles foram extraídos os dados relativos às manifestações da COVID-19 em pés e tornozelos, sendo os achados agrupados em manifestações dermatológicas, neurológicas, vasculares e osteomusculares. A manifestação dermatológica mais prevalente em pé e tornozelo foi a lesão tipo perniose; dentre as manifestações vasculares, destacam-se a trombose arterial, vasculite e isquemia arterial subaguda. Sobre os achados neurológicos, houve descrições de mononeuropatias e polineuropatias, com parestesia e paresia nos pés, hiporreflexia e arreflexia profunda de tornozelo. Dentre os achados osteomusculares, destacam-se as manifestações de artrite reativa (com artralgia em tornozelo e pé, e entesite do tendão do calcâneo, acompanhada por rubor e edema), dactilite e ocorrência de ossificação heterotópica em tornozelo. Conclusão: A COVID-19 causa manifestação ou exacerbação de sintomas vasculares, dermatológicos, neurológicos e osteomusculares em pés e tornozelos.
... Lesions may also blister and ulcerate and there is a poorly understood pathophysiology of the disease; however, it seems to be caused by vasospasm of the vessels [2]. There have also been numerous studies showing a possible connection between pernio and the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); however, no concrete relationship has been established thus far [3]. Pernio mainly affects young and middle-aged women, usually before the age of 40, with a prevalence of 0.9-2.1 per 1000 in women and 0.6 per 1000 in men [4]. ...
... There have been case reports demonstrating that pernio may be a cutaneous manifestation of celiac disease, which this patient did not suffer from [2]. Histological clues that favor idiopathic pernio include keratinocyte necrosis, severe dermal edema, and dermoscopic white dots and lines [3]. Pernio is a disease of clinical diagnosis and skin biopsies are not necessary, unless a physician suspects a different disorder, as it can occur in patients with hematologic disorders, such as paraproteinemia, Raynaud's, systemic lupus erythematosus, viral hepatitis or malignancy, and must be ruled out before suspecting pernio [4]. ...
Pernio, also known as chilblains, presents as erythematous macules at sites of cold exposure, mainly in women. It is a diagnosis that is often overlooked, and when suspecting a patient with pernio, other conditions such as lupus nephritis and Raynaud's must be ruled out. A 46-year-old lady presented to the clinic with skin findings suggestive of pernio. She had erythematous macules on the dorsum of her hands, which appeared during cold weather and lasted for three weeks. She had been suffering with this condition for over 18 years and nothing has helped her condition, other than preventing cold exposure. There are limited treatment options for pernio, and current management includes using steroids, calcium-channel blockers and cold avoidance. Current research has suggested that pernio could also be linked to the severe acute respiratory syndrome coronavirus 2.
... I read with great interest the paper by Jindal et al in which dermoscopic and histological features of idiopathic perniosis (IP) observed in a cohort of Indian patients before SARS-CoV-2 emergence were retrospectively analyzed to explore possible differences with chilblain-like lesions (CLLs) reported in the literature over the ongoing COVID-19 pandemic. [1][2][3] Although several limitations were clearly highlighted by the authors, mainly including the lack of a statistical comparative analysis due to the absence of a CLLs control group and heterogeneity of available literature data, 1 I would like to bring to the reader's attention some additional issues that should be considered in the interpretation of dermoscopy of IP and CLLs. ...
Dermoscopic patterns of inflammatory dermatoses (inflammoscopy) have been extensively studied in the recent years, though data on patients with darker phototypes (IV-VI) are sparse. The aims of this systematic review were to summarize the current state of knowledge on inflammoscopy applied to skin of color and provide a standardized nomenclature of reported findings. Besides dermoscopic features, type of setting and magnification, number of cases, and histopathological correlation were analyzed. Eighty-five papers addressing 76 different dermatoses (25 papulosquamous dermatoses, 19 hyperpigmented dermatoses, seven hypopigmented dermatoses, four granulomatous dermatoses, two sclerotic dermatoses, five facial inflammatory dermatoses, and 14 miscellaneous conditions) for a total of 2073 instances were retrieved. Only one study showed a level of evidence of III (cross-sectional study), whereas 10 and 74 displayed a level of evidence of IV (case-control studies) and V (case-series and case-reports), respectively. Moreover, our analysis also highlighted that most of papers focalized on a limited number of dermatoses, with several conditions having only single dermoscopic descriptions. Additionally, few studies compared findings among phototypes belonging to the “skin of color” spectrum. Further studies designed according to a systematic approach and considering the above-mentioned issues are therefore needed.
Red palms syndrome consists of an intense redness on the palms of the hands and, occasionally, the soles of the feet. This infrequent condition may be primary or secondary. The primary forms are either familial or sporadic. They are always benign and do not require treatment. The secondary forms may have a poor prognosis related to the underlying disease, for which early identification and treatment are imperative. Red fingers syndrome is also rare. It manifests as a persistent redness on the fingers or toes pulp. It is typically secondary either to infectious diseases like human immunodeficiency virus, hepatitis C virus and chronic hepatitis B or to Myeloproliferative Disorders, such as Thrombocythemia and Polycythemia vera. Manifestations spontaneously regress over months or years without trophic alterations. Treatment is limited to that of the underlying condition. Aspirin has been shown effective in Myeloproliferative Disorders.
