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Original Article | Dermatology
1 (
1
); 20-22
doi:
10.25259/RMCGJ_14_2024

Chik sign

Department of Dermatology, Venereology and Leprosy, Rangaraya Medical College, Kakinada, India

*Corresponding author: Ponugoti Meghana, Department of Dermatology, Venereology and Leprosy, Rangaraya Medical College, Kakinada, India ponugotimeghana98@gmail.com

Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Meghana P, Meda S, Ravi SS, Behara SK. Chik sign. RMC Glob J. 2025;1:20–22. doi: 10.25259/RMCGJ_14_2024

Abstract

Objectives

The objective is to study the cutaneous manifestations in suspected cases of Chikungunya fever.

Material and Methods

A study was carried out in the outpatient department of DVL at Government General Hospital in Kakinada, India from July 2024 to September 2024. The study enrolled 24 patients with cutaneous manifestations, a history of fever, and arthralgia.

Results

Out of 24 patients, the Chik sign was found more often in males than in females. The patients showed hyper-pigmentation of the centro-facial region.

Conclusion

The Chik sign is seen in chikungunya fever and other arboviral diseases such as dengue. All patients had negative results on dengue serology. This series of Chik signs plays a significant role in diagnosing patients with Chikungunya in areas with limited resources.

Keywords

Aedes
Arbovirus
Chik sign
Chikungunya
Dengue fever

INTRODUCTION

The Chikungunya virus is an alphavirus transmitted by Aedes aegypti and Aedes. albopictus mosquitoes.1 The symptoms of chikungunya virus infection include pyrexia, chills, headache, arthralgia, and skin rash. Around 15% of cases may involve “silent” infections.2 Chikungunya can affect individuals across all age groups and genders. The chik sign is a skin condition seen in chikungunya fever marked by brownish hyperpigmentation on the nose. This is attributed to higher melanin dispersion and accumulation in the epidermis.3,4 Chik sign is usually seen in patients with Chikungunya fever, but some studies suggest that Chik sign can also be observed in some patients with dengue fever.5

MATERIAL AND METHODS

An observational study was conducted in the DVL department at the Government General Hospital, in Kakinada, Andhra Pradesh, India. This study examined 24 patients with a history of fever, arthralgia, and facial pigmentation.

RESULTS

The study was carried out for 3 months from July 2024 and September 2024 involving 24 cases with a presentation of Chik sign and a history of fever. Among the 24 patients, males were 15 (62.5%) and females were 9 (37.5%) [Chart 1]. The youngest patient was a 25-day-old female, and the oldest was a 50-year-old male. The mean age is 27 years [Chart 2]. Patients were evaluated based on their presentation and detailed history. All the patients had a history of fever and joint pain occurring 1–2 weeks before the appearance of skin manifestations. The investigations advised for all the patients include a complete blood picture, dengue serology (IgM and IgG antibodies), and IgM and IgG antibodies of the chikungunya virus. All 24 patients tested positive for IgM antibodies of the chikungunya virus and negative for dengue serology. There was no significant drug history and skin manifestations before the onset of the disease. Multiple hyperpigmented asymptomatic macules and patches (Chik sign) were seen over the alae and dorsum of the nose [Figure 1] and perinasal area. In a 25-day-old neonate, generalized hyperpigmentation is seen all over the body [Figure 2] Various sites of pigmentation were observed [Table 1]. The most common being the dorsum of the nose, followed by the alae of the nose, cheeks, and trunk. All adult patients are advised to use kojic acid, glycolic acid, and niacinamide combination skin lightening cream with strict sun protection and a neonate-advised moisturizer and sun protection. The reduction of pigmentation starts in 2 weeks after the application of skin lightening cream and the complete reduction was observed in 18 (75%) patients within two months; 80% reduction of pigmentation was observed in 5 (20.8%) patients, and 60% reduction of pigmentation was observed in the neonate after 2 months.

Gender distribution of chik sign.
Chart 1:
Gender distribution of chik sign.
Age distribution of chik sign.
Chart 2:
Age distribution of chik sign.
Chik sign involving alae and dorsum of the nose.
Figure 1:
Chik sign involving alae and dorsum of the nose.
(a) Chik sign in 25-day old neonate involving face and upper limbs. (b) Chik sign involving trunk. (c) Chik sign involving lower limbs.
Figure 2:
(a) Chik sign in 25-day old neonate involving face and upper limbs. (b) Chik sign involving trunk. (c) Chik sign involving lower limbs.
Table 1: Sites of pigmentation in Chikungunya.
Sr. No. Site Number of patients
1 Dorsum of the nose 24 (100%)
2 Alae of the nose 21 (87.5%)
3 Cheeks 20 (83.3%)
4 Trunk 2 (8.3%)

DISCUSSION

Chikungunya fever is a reemerging mosquito-borne pathogen and belongs to the genus Alphavirus, family Togaviridae. It has an incubation period of three days to one week. The symptoms of chikungunya fever are fever, articular pain, exanthem, and headache that arises acutely. The cutaneous manifestations of chikungunya include maculopapular rash, vesicles and bullae, genital aphthae, oral/lip aphthae, axillary pustules and ulcers, desquamation, urticaria/angioedema, purpura/palmar rash, acquired ichthyosis, flared-up tinea, seborrheic dermatitis-like rash, and flare-up of psoriasis. In this case series, the patients present with hyperpigmented macules over the centro-facial region, i.e., the alae and dorsum of the nose and bilateral cheeks (Chik sign).6 Diagnosis of chikungunya is challenging because there are more overlapping symptoms with other arbovirus diseases. Investigations required for the detection of the chikungunya virus include cell culture, nucleic acid testing and detection of specific IgM antibodies using a serological assay. Peripheral health centers often lack the equipment for the diagnosis of chikungunya fever; here, Chik sign plays a vital role in the clinical diagnosis of the disease.

CONCLUSION

The Chik sign is commonly observed in cases of chikungunya fever; it can also be seen in dengue fever. In this series, all 24 patients had a prior history of fever and arthralgia, and their dengue serology was negative. This case series of Chik sign highlights the innocuous and self-limiting nature of nasal pigmentation, which can be a valuable clinical indicator of chikungunya infections in resource-limited settings.

Ethical approval

The research/study approved by the Institutional Review Board at Rangaraya Medical College, number, IEC/RMC/2024/1353, dated 18th October 2024.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Use of artificial intelligence (AI)-assisted technology for manuscript preparation

The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.

REFERENCES

  1. , , , , , , et al. Genome microevolution of chikungunya viruses causing the Indian Ocean outbreak. PLoS Med. 2006;3:e263.
    [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
  2. , , , , , , et al. Serious acute chikungunya virus infection requiring intensive care during the Reunion Island outbreak in 2005–2006. Crit Care Med. 2008;36:2536-41.
    [CrossRef] [PubMed] [Google Scholar]
  3. , , , . The chik sign in dengue. Pediatr Dermatol. 2019;36:737-8.
    [CrossRef] [PubMed] [Google Scholar]
  4. , , , , . Cutaneous manifestations of chikungunya fever: Observations from an outbreak at a tertiary care hospital in Southeast Rajasthan, India. Indian Dermatol Online J. 2017;8:336-42.
    [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
  5. , , , , . Chik sign with dermoscopic findings in 10 patients with dengue: Case Series. Dermatol Pract Concept. 2024;14:e2024187.
    [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
  6. , . “Chik sign” in chikungunya: Three cases with dermoscopic findings. Pigment Int. 2022;9:231-3.
    [Google Scholar]
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