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Letters

Case did not consider all potential causes of chilblains

Catharine L. Dewar
CMAJ September 08, 2020 192 (36) E1046; DOI: https://doi.org/10.1503/cmaj.76376
Catharine L. Dewar
Rheumatologist (retired), Lions Gate Hospital, Vancouver, BC
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I read the CMAJ Practice article on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related chilblains in a 16-year-old female by Ladha and Dupuis1 with interest, but it raised a few concerns. In females in this age group, the association between anorexia nervosa and pernio or chilblains has been noted for several decades.2,3

This case report makes no mention of the patient’s body habitus or body mass index, and there is no description of a physical examination, which is seminal in ruling out autoimmune disorders, such as lupus, or malignant disease. The laboratory investigations are thorough, but a normal chest radiograph and computed tomography scan of the abdomen would have added weight to the final diagnosis of SARS-CoV-2-related chilblains. The dermal pathology of pernio or chilblains is nonspecific4 and, therefore, a skin biopsy is not suggested.4

There is no description of the patient’s smoking history, including e-cigarette usage (“vaping”), as nicotine will exacerbate the vasospasm seen in pernio or chilblains.4

During the current coronavirus disease 2019 pandemic, clinicians are adopting a “hands-off” or telehealth approach to reviewing patients, including history taking. However, there are individuals for whom an office visit and physical examination is important. This may be one of those cases: the positive result for SARS-CoV-2 antibody serology testing may be incidental and unrelated to her skin condition.5

Footnotes

  • Competing interests: None declared.

References

  1. ↵
    1. Ladha MA,
    2. Dupuis EC
    . SARS-CoV-2-related chilblains. CMAJ 2020;192:E804.
    OpenUrlFREE Full Text
  2. ↵
    1. Rustin MHA,
    2. Foreman JC,
    3. Dowd PM
    . Anorexia nervosa associated with acromegaloid features, onset of acrocyanosis and Raynaud’s phenomenon and worsening of chilblains. J R Soc Med 1990; 83:495–6.
    OpenUrlCrossRefPubMed
  3. ↵
    1. White KP,
    2. Rothe MJ,
    3. Milanese A,
    4. et al
    . Perniosis in association with anorexia nervosa. Pediatr Dermatol 1994;11:1–5.
    OpenUrlCrossRefPubMed
  4. ↵
    1. Whitman PA,
    2. Crane JS
    . Pernio (chilblains). In: StatPearls [Internet]. Treasure Island (FL): Stat-Pearls Publishing; 2020. Available: www.ncbi.nlm.nih.gov/books/NBK549842/ (accessed 2020 July 2).
  5. ↵
    1. Ladha MA,
    2. Dupuis EC
    . The authors respond to: “Case did not consider all potential causes of chilbains” [letter]. CMAJ 2020;192:E1047.
    OpenUrlFREE Full Text
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Canadian Medical Association Journal: 192 (36)
CMAJ
Vol. 192, Issue 36
8 Sep 2020
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Case did not consider all potential causes of chilblains
Catharine L. Dewar
CMAJ Sep 2020, 192 (36) E1046; DOI: 10.1503/cmaj.76376

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Case did not consider all potential causes of chilblains
Catharine L. Dewar
CMAJ Sep 2020, 192 (36) E1046; DOI: 10.1503/cmaj.76376
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