JAMA Archives of Dermatology

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Focus on “COVID Toes”

Worldwide case collections of cutaneous manifestations of coronavirus disease 2019 (COVID-19) are ongoing, with acral lesions (similar to classic chilblains) being one of the reported patterns. Also known as pernio-like, pseudo-chilblain, acute acro-ischemia, and “COVID toes,” the pattern of acral lesions is described as erythematous to purple purpuric macules, papules, and/or vesicles. Its close temporal appearance with the COVID-19 pandemic suggests that the two are associated. Galván Casas et al confirmed that 29 of 71 cases of pseudo-chilblains were associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), noting that this pattern is less commonly associated with virologic confirmation. Fernandez-Nieto et al reported that 95 of 132 patients with acro-ischemic changes had a chilblains pattern. Acral lesions often occurred later during the course of COVID-19, and late-stage disease testing was believed to partly account for low positive rates of SARS-CoV-2 infection (2 of 11 patients).

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Chilblains, an Indirect Dermatologic Consequence of the COVID-19 Pandemic

This case series describes 31 patients, most of them teenagers or young adults, who presented with chilblains during the COVID-19 pandemic.

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Insights Into the Biology of Persistent Chemotherapy-Induced Alopecia via Genomic Approaches

A major concern among patients with cancer is hair loss secondary to chemotherapy, an adverse effect that occurs among approximately 65% of patients who undergo this form of therapy. The association between chemotherapy and hair loss is well known across society, and chemotherapy-induced alopecia (CIA) can, therefore, induce a sense of violated privacy, or even shame, among those affected. The association of this adverse effect with reduced self-esteem, social confidence, and sexuality is particularly devastating for women. The anticipation of CIA is so distressing that some female patients even seriously consider refusing chemotherapy treatment.

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Erythematous Nodule With Central Crust on the Nail Fold in an Infant

A girl younger than 2 years presented with a 7-month history of an inflammatory plaque with a central shiny orange crust on her left index finger and no improvement with empiric therapy. What is your diagnosis?

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Incidence and Risk of In situ and Invasive Cutaneous Squamous Cell Carcinoma in the Netherlands

This cohort study uses data from the Netherlands Cancer Registry to assess the incidence rates of cutaneous squamous cell carcinoma in situ and the risk of developing invasive cutaneous squamous cell carcinoma among patients compared with the general population in the Netherlands from 1989 to 2017.

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ABCB1 Gene Variants and Persistent Chemotherapy-Induced Alopecia

This genetic association study explores whether an association exists between genetic factors and the development of persistent chemotherapy-induced alopecia in women with breast cancer who are treated with docetaxel.

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Noninferiority, Model Selection, and Treatment Effects in Observational Research—Reply

In Reply We appreciate the comments of Drs Hopkins and Secrest on our analysis of the survival outcomes after Mohs micrographic surgery (MMS) and wide margin excision (WME) in patients with early-stage invasive melanoma. We agree that the studies referenced in our article were not designed as noninferiority studies and, therefore, equality of outcomes between the 2 treatments cannot be affirmed. Nevertheless, given previous arguments that narrow margins with MMS would lead to poorer outcomes, it is noteworthy that these analyses did not find statistically poorer survival rates for patients treated with MMS vs WME. Drs Hopkins and Secrest also point out that 1 of the referenced studies did not directly compare the 2 techniques. That study reported 100% disease-specific survival following MMS for invasive melanoma, so those results further support the comparable effectiveness of MMS for invasive melanoma relative to published survival rates for patients with this disease who are treated with WME.

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