Coronavirus and children: are chilblains a possible symptom? Let's be clear

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Catherine Le Nevez
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There is something unusual occurring in Del Paese, France, Spain, the United States and even elsewhere in the world: a very unusual increase in the frequency of chilblains on the fingers and especially the feet of children and teenagers. It is inevitable to think of an association with the Covid-19 pandemic. To find out more, we turned to the dermatologist Andrea Locatelli, medical director of the Papa Giovanni XXIII Hospital of the city and member of the board of directors of the Del Paesena Society of pediatric dermatology.

The unusual increase in chilblains in children

"The first reports came about a month ago from various colleagues from all over the country," says Locatelli. "Pediatricians and dermatologists have observed an increase in the frequency of cases in young adults and children and adolescents, especially in the age group between 10 and 18, while younger children seem less interested."

These skin lesions (perniomas, in medical terms) can affect both the feet and the hands, but mainly the feet and can be present both on the right and on the left or in only one district.

"Already these are not particularly frequent lesions, but moreover they started to occur in a season when it is really rare to see them" explains the dermatologist. Emphasizing that they are more common when the climate is cold and humid, certainly not in the first days of spring, such as those that have occurred in recent weeks.

Just to get an idea of ​​the extent of the phenomenon, Locatelli says that in his hospital in past years one or two cases were seen a year, while about twenty have been seen in the last week alone.

The possible association with Covid-19

It is therefore inevitable to think of an association with coronavirus infection, a hypothesis supported by at least two considerations. "On the one hand, the fact that many of the children affected by these chilblains had had mild flu-like symptoms (cough, cold, fever) one or two weeks earlier, or a temporary lack of sense of taste and smell, which would have It could have been symptoms of Covid-19. Others, on the other hand, did not have symptoms of this type but had direct contacts with family members who were positive for coronavirus or who carry out high-risk jobs, such as health workers in hospitals or homes for the elderly ".

In some cases, tampons were made which sometimes, but not always, were positive. "However, remember that swabs have limitations, also linked to the experience of the operators who perform them, so the risk of obtaining false negatives is quite high".

"In addition to this, there is the fact that reports of clinical cases of various ages showing skin manifestations in association with coronavirus infection are multiplying in the scientific literature."

According to Locatelli and other experts, therefore, it is possible that the chilblains that appear on the hands and feet of children and adolescents in this period are late symptoms of Covid-19, possibly manifested in a mild or asymptomatic form. "The hypothesis is that there is the activation of an inflammatory cascade that leads to irritation of the blood vessels, with a tendency to vasoconstriction in areas that are already colder than the rest of the body, such as the extremities. Of course, other data are needed for try all this and we, like others in Del Paese and around the world, are organizing ourselves to do research in this sense ".

Read also: Children and coronavirus: now more than ever let's not forget about free play

What to do if the child has chilblains on the hands or feet

"First of all, do not worry, because even if it were really a symptom of Covid-19, we know that children with this infection do not generally show important symptoms" reassures Locatelli. Furthermore, it could be a late symptom, which signals the exit from the disease. "As a precaution, however, I would avoid contact between these children and grandparents, who are the subjects most at risk, except in case of absolute necessity and with all the necessary precautions, therefore with a mask and at a distance of at least one meter".

As for the management of the lesions, "if they cause itching or burning, they can be treated locally with a cortisone anti-inflammatory ointment, and in the most important cases also with an antibiotic ointment".

Finally, Locatelli invites parents to take children with chilblains to the dermatologist even if they have no other symptoms. "A registry has been organized to collect as many cases as possible: gathering information at this stage, especially as regards asymptomatic subjects or those with few symptoms, is in fact essential to learn more about this virus with which we will probably have to live for a long time yet".

  • coronavirus
  • 3-5 children years
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