Chik Sign : Indian Journal of Paediatric Dermatology

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Chik Sign

Sheth, Preeti Keyur1,; Vasani, Resham1,2

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Indian Journal of Paediatric Dermatology: Jul–Sep 2022 - Volume 23 - Issue 3 - p 258-259
doi: 10.4103/ijpd.ijpd_4_22
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A 10-day-old female neonate presented with progressive generalized pigmentation of the body noticed by the mother since the 5th day of life. Blackish discoloration began on the face [Figure 1] and progressively involved the nose, lips, and rest of the body [Figures 2 and 3]. Drug history was noncontributory. On examination, ill-defined mottled pigmentation in a generalized distribution with predominance on the face, particularly the nose, was noted. Neurological, renal, and ophthalmological examination revealed no abnormalities. Basic hematological investigations including serum cortisol and Vitamin B12 levels were normal. Considering the positive maternal history of chikungunya fever in the 8th month of pregnancy, the neonate was tested for chikungunya immunoglobulin M antibodies, which came positive. Hence, this case was diagnosed as congenital chikungunya due to vertical transmission with generalized pigmentation and accentuation of pigmentation on the nose – “Chik sign” being the prominent feature. The mother was assured about the transient nature of the pigmentation.

Figure 1:
Chik sign of chikungunya – accentuation of pigmentation on the nose
Figure 2:
Generalized ill-defined mottled pigmentation
Figure 3:
Ill-defined pigmentation with scaling

The risk of vertical transmission in chikungunya is highest at the time of delivery. The neonate can present with fever, neurological symptoms, and a myriad of cutaneous manifestations.[1] Mothers afflicted with chikungunya in the 3rd trimester of pregnancy may produce babies with centrofacial pigmentation. This could be the possible reason for dermatological manifestations without systemic involvement in our case.

Chik sign is an identifiable feature in the diagnosis of congenital chikungunya. This is essentially helpful in resource-poor settings where serological confirmation may not always be possible.[2]

Declaration of consent

The authors certify that they have obtained all appropriate consent forms, duly signed by the parent(s)/guardian(s) of the patient. In the form, the parent(s)/guardian(s) has/have given his/her/their consent for the images and other clinical information of their child to be reported in the journal. The parents understand that the names and initials of their child/children will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.


1. Vasani R, Kanhere S, Chaudhari K, Phadke V, Mukherjee P, Gupta S, et al Congenital Chikungunya – A cause of neonatal hyperpigmentation Pediatr Dermatol. 2016;33:209–12
2. Chandramathi J, Prabhu A, Kumar A. The “Chik Sign” in neonatal Chikungunya Rev Soc Bras Med Trop. 2020;53:e20200157
© 2022 Indian Journal of Paediatric Dermatology | Published by Wolters Kluwer – Medknow