Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Medical Practice Evaluation Center, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts.
Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
J Am Acad Dermatol. 2020 Aug;83(2):486-492. doi: 10.1016/j.jaad.2020.05.109. Epub 2020 May 30.
Increasing evidence suggests pernio-like lesions are cutaneous manifestations of coronavirus infectious disease 2019 (COVID-19).
To describe clinical and pathologic findings of pernio-like lesions in patients with confirmed or suspected COVID-19.
An international dermatology registry was circulated to health care providers worldwide through the American Academy of Dermatology, International League of Dermatologic Societies, and other organizations.
We documented 505 patients with dermatologic manifestations associated with COVID-19, including 318 (63%) with pernio-like lesions. Patients with pernio-like lesions were generally young and healthy, with relatively mild COVID-19. Of 318 patients with confirmed or suspected COVID-19 by providers, 23 (7%) were laboratory-confirmed COVID-19 positive, and 20 others (6%) were close contacts of patients with confirmed COVID-19. Given current testing criteria, many patients lacked COVID-19 testing access. For 55% of patients, pernio-like lesions were their only symptom. In patients with other COVID-19 symptoms, pernio-like lesions typically appeared after other symptoms. Pernio-like lesions lasted a median of 14 days (interquartile range, 10-21 days).
A case series cannot estimate population-level incidence or prevalence. In addition, there may be confirmation bias in reporting. We cannot exclude an epiphenomenon.
Pernio-like skin changes of the feet and hands, without another explanation, may suggest COVID-19 infection and should prompt confirmatory testing.
越来越多的证据表明冻疮样病变是 2019 年冠状病毒病（COVID-19）的皮肤表现。
描述确诊或疑似 COVID-19 患者冻疮样病变的临床和病理表现。
通过美国皮肤病学会、国际皮肤科学会联盟和其他组织向全球医疗保健提供者分发了一份国际皮肤病学登记处。
我们记录了 505 例与 COVID-19 相关的皮肤科表现患者，其中 318 例（63%）有冻疮样病变。冻疮样病变患者通常年轻且健康，COVID-19 相对较轻。在 318 例经提供者确诊或疑似 COVID-19 的患者中，23 例（7%）实验室确诊 COVID-19 阳性，另有 20 例（6%）为确诊 COVID-19 患者的密切接触者。鉴于当前的检测标准，许多患者无法进行 COVID-19 检测。对于 55%的患者，冻疮样病变是他们唯一的症状。在有其他 COVID-19 症状的患者中，冻疮样病变通常在其他症状出现后出现。冻疮样病变的中位持续时间为 14 天（四分位间距，10-21 天）。
病例系列无法估计人群水平的发病率或患病率。此外，在报告中可能存在确认偏倚。我们不能排除偶发现象。
无其他解释的手脚冻疮样皮肤改变可能提示 COVID-19 感染，应进行确认性检测。
