John Libbey Eurotext

European Journal of Dermatology

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Chilblains observed during the COVID-19 pandemic cannot be distinguished from classic, cold-related chilblains Volume 32, numéro 3, May-June 2022

Illustrations

  • Figure 1.
  • Figure 2.
  • Figure 3.
Auteurs
1 Department of Dermatology, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Avenue Hippocrate 10, 1200, Brussels, Belgium
2 de Duve institute, Université catholique de Louvain, Brussels, Belgium
3 Institute of Experimental and Clinical Research, Pneumology, ENT and Dermatology Pole, Université catholique de Louvain, Brussels, Belgium
4 Institute of Experimental and Clinical Research, Imaging Platform (2IP), Université catholique de Louvain, Brussels, Belgium
5 Department of Anatomopathology, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Avenue Hippocrate 10, 1200, Brussels, Belgium
a These authors contributed equally
Reprints: Marie Baeck

Background

Type 1 interferon (IFN-I) response induced by SARS-CoV-2 has been hypothesized to explain the association between chilblain lesions (CL) and SARS-CoV-2 infection.

Objective

To explore direct cytopathogenicity of SARS-CoV-2 in CL and to focus on IFN-I expression in patients with chilblains.

Materials & Methods

A monocentric cohort of 43 patients presenting with CL from April 2020 to May 2021 were included. During this period, all CL were, a priori, considered to be SARS-CoV-2-related. RT-qPCR on nasopharyngeal swabs and measurements of anti-SARS-CoV-2 antibodies were performed. Anti-SARS-CoV-2 immunostainings as well as SARS-CoV-2 RT-qPCR were performed on biopsy specimens of CL and controls. Expression of MX1 and IRF7 was analysed on patients’ biopsy specimens and/or PBMC and compared with controls and/or chilblains observed before the pandemic. Serum IFN-α was also measured.

Results

RT-qPCR was negative in all patients and serological tests were positive in 11 patients. Immunostaining targeting viral proteins confirmed the lack of specificity. SARS-CoV-2 RNA remained undetected in all CL specimens. MX1 immunostaining was positive in CL and in pre-pandemic chilblains compared to controls. MX1 and IRF7 expression was significantly increased in CL specimens but not in PBMC. Serum IFN-α was undetected in CL patients.

Conclusion

CL observed during the pandemic do not appear to be directly related to SARS-CoV-2 infection, either based on viral cytopathogenicity or high IFN-I response induced by the virus.

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