Irene Hartmann
07/27/2020 - 0:05
- Clarín.com
- Society
You wake up with blisters on your hands. The next day they get worse. To the other, more. Tand it hurts. Fingers swell like hot red sausages. The injuries are suddenly concentrated on the knuckles; they become visible. You do not know if it burns you, if it itches you or both, but the worst is with the cold: it feels as if an open wound is being scrubbed with virulana. You do a teleconsultation, you do two, three, four. Clinicians don't know. They medicate you erratically. Finally, a lucid rheumatologist names the whole: " Erythema pernio or perniosis , what the old women called chilblains ." It was seven weeks ago and it happened to this chronicler. The story would be insignificant if it were not for the same thing happening to dozens of people (no one knows how many) who break into the guards with chilblains on their hands and feet.. Dermatologists assure that it is due to the coronavirus.
Marina Scolnik, rheumatologist at the Italian Hospital, warned her a few days ago.: “I was seeing more cases like yours. It is striking. Normally I don't see more than one case of perniosis per year, but I've seen six or seven this winter. And not only me: also other rheumatologists with whom I was speaking ”.
What are chilblains? Simple, said José Stringa, a dermatologist at the Hospital de Clínicas: “Chilblain is a hot, red, erythematous plaque or nodule that sometimes itches, sometimes burns, sometimes hurts, which appears on the hands and feet, much more common in rural areas than in the city, due to the greater exposure to cold . The traditional chilblain, which is ultimately a circulatory disorder , could also be seen in the nose or ears, but since the pandemic began, we are seeing them more in the feet, and also in the hands. ”
Stringa is also surprised by the notable increase in consultations: “I don't know statistically, but I am 38 years old as a dermatologist working in the urban environment. I saw very few chilblains in my life, maybe ten. Only this week I have already seen four patients with chilblains ”.
Feet with chilblains, technically called perniosis or erythema pernio, a circulatory disorder now linked to the coronavirus.
Margarita Larralde, head of the Dermatology service at the German Hospital and full professor at the UBA Faculty of Medicine, assured that she usually has one or two cases of perniosis throughout the year, but that now, like several of her colleagues, she is seeing " two to three cases per day ".
The link with the pandemic is an unresolved issue, the focus of a heated controversy between dermatologists and rheumatologists. Proof of this are the recent comings and goings that can be read online in the Annals of Pediatrics, where two opposing positions raised mainly by Spanish specialists are in conflict: the increase in skin lesions is seen "in Spain and in several other countries, "Stringa said.
Some say the cause is quarantine. Others, the Covid-19 . The former argue that perniosis is an anomalous response to cold, and since sedentary lifestyle tends to lower body temperature, confinement would clearly explain the multiplication of these pictures.
In this regard, Larralde pointed out that “this position does not make sense, since many of the cases that are reported are of boys, who are the ones that are most on the move. In addition, in Spain they were not even in winter. And here, in Argentina, except for the last few days, it was not too cold either. It is clearly a sign of coronavirus . ”
Those in the first group allege another central theme: by swabbing these patients, PCR and antibody tests, in most cases, are negative. At this point, a group of researchers from the "other side" has a paper in the process of being published in the Annals ..., entitled "Perniosis of confinement, an old woman known in the context of COVID-19". There they affirm that "the fact that, in many cases, not in all, a positive RT-PCR for SARS-CoV-2 has not been obtained, does not indicate that there has been no infection, only that this type of injury would represent manifestations delays of COVID-19 infection in healthy young subjects, since the positivity for PCR has a limited duration over time ”.
Another example of feet with chilblains in a pediatric patient.
As for the antibody tests, they clarify: “There are few published cases in which serologies were performed, being negative in some cases. However, the low sensitivity of rapid IgG / IgM tests or the timing of these tests could explain a negative result. "
Larralde and Stringa agreed that the patients they are seeing have varied ages, but they are mostly young, many of them, boys. Larralde also added: “When the patient is asked what he did in recent weeks, it turns out that in many cases they were close to someone infected with Covid, so there are no doubts. And it happened to me of having a boy with chilblains -without other symptoms-, whose father a few days later manifested a fever ”.
According to Stringa, “although it is true that for now only 20% are testing positive for antibodies , it is complex because there are cases of people with chilblains that seem to manifest late with respect to Covid, and others who show the signs simultaneously. In any case, the perniosis symptoms last between two and three weeks ”.
Should these skin signs be included as another “suspected case” figure for coronavirus? The dermatologist clarified his position: “At this time, chilblain is not considered in itself a symptom related to Covid. It is a novelty and in medicine you have to wait for the truth of the situation to be verified. But the increase in chilblain patients in the pandemic is notable. And, in this sense, it is highly suggestive in this context . The link with the pandemic is a fact. I am sure the health authorities are aware of this. "
Manual for living with a coronavirus infected
Watch the SpecialWhat is Coronavirus? How is it spread and what are its symptoms?
Watch the specialDD
