The skin reddening and swelling reported in children that became headlines in news sites during the pandemic, or popularly known as “COVID-toes,” might not be linked to the novel coronavirus infection, according to a new study which found these swelling in infants who tested negative from COVID-19.
In an earlier report by Science Times in April, children in Italy has shown unusual toe marks dubbed as the new symptom of coronavirus infection. The red swelling is caused by inflammation of tiny blood cells, prevalent in children and adolescents.
In Spain, researchers from the La Fe University Hospital assessed 32 patients, including 20 children and adolescents, who experienced the bizarre swelling of the toes between April 9 and April 15.
But current study, published in JAMA Dermatology, did not find any evidence that the skin lesions are associated with COVID-19.
COVID-Toes Not Caused by Coronavirus
COVID-toes or also referred to as acute acro-ischemia, have been reported as a possible symptom of COVID-19 in earlier studies. So scientists, including Juncal Roca-Gines, in the current research evaluated the mechanism by which these acute skin lesions formed.
They performed RT-PCR diagnostic test for COVID-19 patients and various blood tests for the possible origins of the lesions.
Furthermore, the researchers also performed skin tissue sample analysis in six COVID-19 patients. Of the 20 patients who participated in the study, seven were female, and 13 were male, whose age ranges between one to 18 years old.
The findings showed that none of the patients had remarkable blood abnormalities and antibodies to the coronavirus. The skin sample analyses showed that the inflammation showed characteristics of an inflammatory condition called perniosis.
Based on their observations, the scientists said three different scenarios might explain the abrupt appearance of these acute skin lesions during the peak of the pandemic on patients who tested negative of COVID-19.
“One possibility is that the patients were in a very early stage of the disease, which would explain the negativity of PCR and serologic test results,” the researchers explained.
The second explanation is that the skin lesions are sub-acute manifestations of the infection, in which patients were once infected, but have shown no traces of the virus when they were tested.
Lastly, the third possibility is that low quantities of the virus in the patients may have caused them not to develop clinical symptoms since the virus is undetectable during the tests. In this scenario, the only manifestations of COVID-19 in children are the skin lesions ad formation of tiny blood vessels of the extremities, which includes the toes.
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Relationship Between COVID-19 and Acute Skin Lesions Not Determined
The researchers noted that although acute skin lesions are most commonly found in patients with pre-existing conditions such as hypertension, diabetes, and obesity, the absence of these risk factors in the children in the study does not support this explanation.
The researchers concluded that: “In this case series of 20 children and adolescents, a relationship between acute acral skin changes and Covid-19 could not be demonstrated.”
Since extensive testing failed to identify other risk factors for the lesions, the researchers suspect that lifestyle changes might have caused them. These include walking barefoot in unheated homes, and time spent in sedentary positions.
The researchers recommend a more extensive study with improved microbiological tests or molecular techniques to show the presence of the novel coronavirus particles in the skin will help validate the findings of the study.
The scientists, including Claudia Hernandez, Section director of JAMA Dermatology, said that it is still unclear whether the viral infection process or some other mechanism is responsible for COVID-toes.
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