{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T07:26:59Z","timestamp":1780471619745,"version":"3.54.1"},"reference-count":18,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2020,6,29]],"date-time":"2020-06-29T00:00:00Z","timestamp":1593388800000},"content-version":"vor","delay-in-days":59,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Dermatology"],"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background\/Objectives<\/jats:title><jats:p>A recent marked increase in pediatric and adult patients presenting with purpuric acral lesions concerning for ischemia, thrombosis and necrosis has been observed in COVID\u201019 prevalent regions worldwide. The clinical and histopathological features and relationship to COVID\u201019 have not been well described. The objective of this case series is to describe the clinical features and determine the histopathologic findings and clinical implications of the clusters of acral perniosis cases identified in pediatric patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We describe six otherwise healthy adolescents\u2014three siblings per family from two unrelated families\u2014presented within a 48\u2010hour period in April, 2020, with acral perniosis\u2010like lesions in the context of over 30 similar patients who were evaluated within the same week.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Affected patients had mild symptoms of viral upper respiratory infection (URI) or contact with symptomatic persons 1\u20102\u00a0weeks preceding the rash. They all presented with red to violaceous macules and dusky, purpuric plaques scattered on the mid and distal aspects of the toes. Skin biopsies performed on each of the six patients demonstrated near identical histopathologic findings to those of idiopathic perniosis, with a lymphocytic inflammatory infiltrate without evidence of thromboembolism or immune complex vasculitis. While SARS\u2010CoV\u20102 polymerase chain reaction was negative, testing was performed 1\u20102\u00a0weeks after URI symptoms or sick contact exposure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We offer a clinical approach to evaluation of patients with this presentation and discuss the possibility that these skin findings represent a convalescent\u2010phase cutaneous reaction to SARS\u2010CoV\u20102 infection.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pde.14227","type":"journal-article","created":{"date-parts":[[2020,5,12]],"date-time":"2020-05-12T21:40:05Z","timestamp":1589319605000},"page":"419-423","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":86,"title":["Clustered cases of acral perniosis: Clinical features, histopathology, and relationship to COVID\u201019"],"prefix":"10.1111","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9158-2111","authenticated-orcid":false,"given":"Kelly M.","family":"Cordoro","sequence":"first","affiliation":[{"name":"Department of Dermatology and Pediatrics University of California San Francisco Benioff Children\u2019s Hospital San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3760-3676","authenticated-orcid":false,"given":"Sean D.","family":"Reynolds","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Pediatrics University of California San Francisco Benioff Children\u2019s Hospital San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Wattier","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Division of Infectious Diseases and Global Health University of California San Francisco Benioff Children\u2019s Hospital San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy H.","family":"McCalmont","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Pathology University of California San Francisco San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,6,29]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"MazzottaF TroccoliT.Acute Acro\u2010Ischemia in the child in the time of COVID\u201019. 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