Department of Dermatology, Icahn School of Medicine at Mt Sinai, New York, New York.
Division of Allergy and Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mt Sinai, New York, New York.
Clin Dermatol. 2021 Jan-Feb;39(1):84-91. doi: 10.1016/j.clindermatol.2020.12.016. Epub 2021 Jan 14.
The emergence of the coronavirus disease 2019 (COVID-19) worldwide pandemic has been associated with a new constellation of cutaneous features in children. Among the unusual dermatologic presentations are the so-called COVID toes, inflammatory nodules of the feet and toes, sometimes involving the hands and fingers. These lesions mimic acral pernio, the synonym being chilblains. Unlike adult patients with COVID toes, children are less likely to manifest symptomatic COVID-19. Although a few studies have found some linkage to COVID-19 through the serum IgA or IgG severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein, other studies have no demonstrable linkage suggesting that barefoot children in cold weather develop such lesions. It appears that the chilblain-like lesions related to the period of the COVID-19 pandemic may reflect a brisk immune response portending a good prognosis and perhaps some form of innate immunity. The possible need to screen for coagulopathy is unclear, but this has been suggested in one report. Until we fully understand the pattern of immune response to COVID-19, questions may persist as to how disease manifestations are linked to SARS-CoV-2 exposures.
新型冠状病毒病（COVID-19）在全球大流行，与儿童出现一系列新的皮肤特征有关。不常见的皮肤表现包括所谓的“COVID 脚趾”，即足部和脚趾的炎症性结节，有时也会累及手部和手指。这些病变类似于冻疮，其同义词为冻疮。与 COVID 脚趾的成年患者不同，儿童不太可能出现有症状的 COVID-19。尽管少数研究通过血清 IgA 或 IgG 严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）刺突蛋白发现了与 COVID-19 的一些关联，但其他研究并未发现明显的关联，表明在寒冷天气赤脚的儿童会出现此类病变。似乎与 COVID-19 大流行期间相关的冻疮样病变反映了迅速的免疫反应，预示着良好的预后，也许还存在某种形式的先天免疫。是否需要筛查凝血功能障碍尚不清楚，但有一份报告提出了这一建议。在我们充分了解对 COVID-19 的免疫反应模式之前，关于疾病表现与 SARS-CoV-2 暴露之间的关联，可能仍存在疑问。
