Episode Details

Covid toe, caused by the immune response to the virus, not the virus itself

Uploaded 08-10-21

https://covidskinsigns.com

https://onlinelibrary.wiley.com/doi/full/10.1111/bjd.20707

Objectives

To study skin and blood endothelial and immune system activation

In chilblain-like lesions (CLL),

CLL in comparison with healthy controls and seasonal chilblains (SC)

(cold-induced sporadic chilblains occurring during 2015 and 2019)

Methods

Observational study

Saint-Louis Hospital, Paris, France

N = 50

Cytokine assays

Assessment of interferon-stimulated gene expression in whole blood

Soluble markers of endothelial activation and/or angiogenesis

Histological examinations

Lateral flow spike assay

Circulating endothelial cell counting

Statistical analysis

Results

Histological patterns were similar in CLL and SC groups

Transcriptomic signatures overlapped in both the CLL and SC groups

Type I interferon

Cytotoxic–natural killer gene signature

CLL were characterized by higher IgA tissue deposition

More complement and angiogenesis factors in CLL compared with SC

Autoimmune vasculitis

Confirmed endothelial dysfunction in CLL

Microangiopathy leading to clinical chilblains

Disrupt the thrombo-protective state of endothelial cells

Likely contributing to microvascular thrombosis

Systemic endothelial activation?

The PT ratio and aPTT were normal in all patients

Only three patients (6%) had a moderate increase in D-dimer levels

Conclusions

Inflammation in the skin in CLL

Associated with endothelial alteration

Immune infiltration of cytotoxic and type I IFN-leading to clinical manifestations

https://www.bbc.co.uk/news/health-58801462

UK podiatrist Dr Ivan Bristow

like the regular chilblains typically seen during cold spells and in people who have problems with circulation - the lesions usually go away on their own.

But some may need treatment with creams and other drugs.

The confirmation of the cause will help to develop new treatments to manage it more effectively


Dr Veronique Bataille, consultant dermatologist, British Skin Foundation

Covid toe was seen very frequently during the early phase of the pandemic, but has been less common in the current Delta variant wave.

That might be down to more people being vaccinated or having some protection against Covid from past infections.

Presentations after vaccination are much rarer

Delayed presentation my mean link is missed

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