{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T07:25:47Z","timestamp":1780471547042,"version":"3.54.1"},"reference-count":35,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2020,7,2]],"date-time":"2020-07-02T00:00:00Z","timestamp":1593648000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acad Dermatol Venereol"],"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Acral chilblain\u2010like lesions are being increasingly reported during COVID\u201019 pandemic. However, only few patients proved positivity for SARS\u2010CoV\u20102 infection. The relationship between this skin manifestation and COVID\u201019 infection has not been clarified yet.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To thoroughly characterize a prospective group of patients with chilblain\u2010like lesions and to investigate the possible relationship with SARS\u2010CoV\u20102 infection.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Following informed consent, patients underwent (i) clinical evaluation, (ii) RT\u2010PCR and serology testing for SARS\u2010CoV\u20102, (iii) digital videocapillaroscopy of finger and toe nailfolds, (iv) blood testing to screen for autoimmune diseases and coagulation anomalies, and (v) skin biopsy for histopathology, direct immunofluorescence and, in selected cases, electron microscopy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Nineteen patients, all adolescents (mean age: 14\u00a0years), were recruited. 11\/19 (58%) of them and\/or their cohabitants reported flu\u2010like symptoms one to two months prior to skin manifestation onset. Lesions were localized to toes and also heels and soles. Videocapillaroscopy showed pericapillary oedema, dilated and abnormal capillaries, and microhaemorrhages both in finger and toe in the majority of patients. Major pathological findings included epidermal basal layer vacuolation, papillary dermis oedema and erythrocyte extravasation, perivascular and perieccrine dermal lymphocytic infiltrate, and mucin deposition in the dermis and hypodermis; dermal vessel thrombi were observed in two cases. Blood examinations were normal. Nasopharyngeal swab for SARS\u2010CoV\u20102 and IgG serology for SARS\u2010CoV\u20102 nucleocapsid protein were negative. Importantly, IgA serology for S1 domain of SARS\u2010CoV\u20102 spike protein was positive in 6 patients and borderline in 3.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Chilblain\u2010like lesions during COVID\u201019 pandemic have specific epidemiologic, clinical, capillaroscopic and histopathological characteristics, which distinguish them from idiopathic perniosis. Though we could not formally prove SARS\u2010CoV\u20102 infection in our patients, history data and the detection of anti\u2010SARS\u2010COV\u20102 IgA strongly suggest a relationship between skin lesions and COVID\u201019. Further investigations on the mechanisms of SARS\u2010CoV\u20102 infection in children and pathogenesis of chilblain\u2010like lesions are warranted.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jdv.16682","type":"journal-article","created":{"date-parts":[[2020,5,31]],"date-time":"2020-05-31T19:14:36Z","timestamp":1590952476000},"page":"2620-2629","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":117,"title":["A clinical, histopathological and laboratory study of 19 consecutive Italian paediatric patients with chilblain\u2010like lesions: lights and shadows on the relationship with COVID\u201019 infection"],"prefix":"10.1111","volume":"34","author":[{"given":"M.","family":"El Hachem","sequence":"first","affiliation":[{"name":"Dermatology Unit Bambino Ges\u00f9 Children\u2019s Hospital IRCCS Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0879-9825","authenticated-orcid":false,"given":"A.","family":"Diociaiuti","sequence":"additional","affiliation":[{"name":"Dermatology Unit Bambino Ges\u00f9 Children\u2019s Hospital IRCCS Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Concato","sequence":"additional","affiliation":[{"name":"Virology Unit Bambino Ges\u00f9 Children\u2019s Hospital IRCCS Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Carsetti","sequence":"additional","affiliation":[{"name":"Diagnostic Immunology Unit Department of Laboratories B Cell Pathophysiology Unit, Immunology Research Area Bambino Ges\u00f9 Children\u2019s Hospital IRCCS Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5610-9580","authenticated-orcid":false,"given":"C.","family":"Carnevale","sequence":"additional","affiliation":[{"name":"Dermatology Unit Bambino Ges\u00f9 Children\u2019s Hospital IRCCS Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Ciofi Degli Atti","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Unit Bambino Ges\u00f9 Children\u2019s Hospital IRCCS Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Giovannelli","sequence":"additional","affiliation":[{"name":"Medical Laboratory Unit Bambino Ges\u00f9 Children\u2019s Hospital IRCCS Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Latella","sequence":"additional","affiliation":[{"name":"Dermatology Unit Bambino Ges\u00f9 Children\u2019s Hospital IRCCS Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"O.","family":"Porzio","sequence":"additional","affiliation":[{"name":"Medical Laboratory Unit Bambino Ges\u00f9 Children\u2019s Hospital IRCCS Rome Italy"},{"name":"Department of Experimental Medicine University of Rome Tor Vergata Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Rossi","sequence":"additional","affiliation":[{"name":"Pathology Unit Bambino Ges\u00f9 Children\u2019s Hospital IRCCS Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Stracuzzi","sequence":"additional","affiliation":[{"name":"Pathology Unit Bambino Ges\u00f9 Children\u2019s Hospital IRCCS Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Zaffina","sequence":"additional","affiliation":[{"name":"Occupational Medicine Bambino Ges\u00f9 Children's Hospital IRCCS Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Onetti Muda","sequence":"additional","affiliation":[{"name":"Department of Laboratories Bambino Ges\u00f9 Children's Hospital IRCCS Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Zambruno","sequence":"additional","affiliation":[{"name":"Genetics and Rare Diseases Research Division Bambino Ges\u00f9 Children\u2019s Hospital IRCCS Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Alaggio","sequence":"additional","affiliation":[{"name":"Pathology Unit Bambino Ges\u00f9 Children\u2019s Hospital IRCCS Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,7,2]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1024\/0301-1526\/a000838"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2013.09.020"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2001316"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tmaid.2020.101623"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11427-020-1661-4"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2020-0702"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/jdv.16387"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/jdv.16544"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjd.19163"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/ced.14243"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/ced.14255"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/jdv.16526"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/jdv.16572"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/ced.14275"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2020.05.120"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/ijd.14937"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ad.2020.04.002"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdcr.2020.04.011"},{"key":"e_1_2_6_20_1","first-page":"e13516","article-title":"Chilblain\u2010like lesions in pediatrics dermatological outpatients during the COVID\u201019 outbreak [published online ahead of print]","author":"Garcia\u2010Lara G","year":"2020","journal-title":"Dermatol Ther"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/pde.14210"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/jdv.16592"},{"key":"e_1_2_6_23_1","article-title":"Chilblains are a common cutaneous finding during the COVID\u201019 pandemic: a retrospective nationwide study from France","author":"Masson A","year":"2020","journal-title":"J Am Acad Dermatol"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.5114\/reum.2016.60215"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.autrev.2020.102458"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/DAD.0b013e3181af1d24"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.2174\/1573397113666170726120344"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.3109\/s10165-012-0768-9"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1067\/mjd.2001.117861"},{"key":"e_1_2_6_30_1","doi-asserted-by":"publisher","DOI":"10.1097\/DAD.0000000000000945"},{"key":"e_1_2_6_31_1","doi-asserted-by":"publisher","DOI":"10.1097\/CM9.0000000000000774"},{"key":"e_1_2_6_32_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.8259"},{"key":"e_1_2_6_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cca.2020.04.026"},{"key":"e_1_2_6_34_1","doi-asserted-by":"publisher","DOI":"10.1038\/mi.2007.6"},{"key":"e_1_2_6_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.virusres.2014.03.018"},{"issue":"7","key":"e_1_2_6_36_1","article-title":"Severe acute respiratory syndrome coronavirus 2\u2212specific antibody responses in coronavirus disease 2019 patients [published online ahead of print]","volume":"26","author":"Okba NMA","year":"2020","journal-title":"Emerg Infect Dis"}],"container-title":["Journal of the European Academy of Dermatology and Venereology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jdv.16682","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jdv.16682","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jdv.16682","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,3]],"date-time":"2023-09-03T19:47:02Z","timestamp":1693770422000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jdv.16682"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,7,2]]},"references-count":35,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2020,11]]}},"alternative-id":["10.1111\/jdv.16682"],"URL":"https:\/\/doi.org\/10.1111\/jdv.16682","archive":["Portico"],"relation":{},"ISSN":["0926-9959","1468-3083"],"issn-type":[{"value":"0926-9959","type":"print"},{"value":"1468-3083","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,7,2]]},"assertion":[{"value":"2020-05-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-05-18","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-07-02","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}