{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,26]],"date-time":"2025-10-26T21:40:53Z","timestamp":1761514853547,"version":"3.40.5"},"reference-count":24,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2022,1,5]],"date-time":"2022-01-05T00:00:00Z","timestamp":1641340800000},"content-version":"vor","delay-in-days":4,"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":[[2022,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Since the beginning of the coronavirus disease 2019 (COVID\u201019) pandemic, an increasing number of chilblain\u2010like lesions (ChLL) have been increasingly reported worldwide. To date, the causal link between ChLL and SARS\u2010CoV\u20102 infection has not been unequivocally established.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this case series, we present demographic, clinical, laboratory, and histopathological information regarding 27 young patients with a clinical diagnosis of ChLL who referred to the Dermatology Unit of Papa Giovanni XXIII Hospital, Bergamo, Italy, from 1 April 2020 to 1\u00a0June 2020.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The mean age was 14.2\u00a0years, and 21 patients (78%) experienced mild systemic symptoms a median of 28\u00a0days before the onset of cutaneous lesions. ChLL mostly involved the feet (20 patients \u2013 74%). Among acral lesions, we identified three different clinical patterns: (i) chilblains in 20 patients (74%); (ii) fixed erythematous macules in 4 children (15%); (iii) erythrocyanosis in 3 female patients (11%). Blood examinations and viral serologies, including parvovirus B19, cytomegalovirus (CMV), Epstein\u2010Barr virus (EBV), and coxsackievirus were normal in all. Three patients (11%) underwent nasopharyngeal swab for RT\u2010PCR for SARS\u2010CoV\u20102\u00a0showing only 1 positive. Histopathological examinations of 7\u00a0skin biopsies confirmed the clinical diagnosis of chilblains; vessel thrombi were observed only in 1 case. Our findings failed to demonstrate the direct presence of SARS\u2010CoV\u20102 RNA in skin biopsies, both with real\u2010time polymerase chain reaction (RT\u2010PCR) and RNAscope in situ hybridization (ISH).<\/jats:p><\/jats:sec><jats:sec><jats:title>Limitations<\/jats:title><jats:p>Limited number of cases, unavailability of laboratory confirmation of COVID\u201019 in all patients, potential methodological weakness, and latency of skin biopsies in comparison to cutaneous lesions onset.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>These observations may support the hypothesis of an inflammatory pathogenesis rather than the presence of peripheral viral particles. Although, we could not exclude an early phase of viral endothelial damage followed by an IFN\u2010I or complement\u2010mediated inflammatory phase. Further observations on a large number of patients are needed to confirm this hypothesis.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pde.14903","type":"journal-article","created":{"date-parts":[[2022,1,6]],"date-time":"2022-01-06T04:10:34Z","timestamp":1641442234000},"page":"77-83","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["RNAscope in situ hybridization and RT\u2010PCR for detection of SARS\u2010CoV\u20102\u00a0in chilblain\u2010like lesions: A clinical, laboratory and histopathological study"],"prefix":"10.1111","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9618-7601","authenticated-orcid":false,"given":"Elisa","family":"Robustelli Test","sequence":"first","affiliation":[{"name":"Dermatology Unit ASST Papa Giovanni XXIII Hospital  Bergamo Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolo","family":"Sena","sequence":"additional","affiliation":[{"name":"Dermatology 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