Chilblain-Like Skin Lesions as a Cutaneous Presentation of COVID-19 in Children

Group of kids return to school during the pandemic.
Chilblain-like skin lesions in children during the COVID-19 pandemic are investigated.

Chilblain-like skin lesions—also known as perniosis-like skin lesions—are a cutaneous presentation of COVID-19 infection in children. A systematic review of articles on the topic was conducted, in order to explore any predisposition, location, prognosis, and clinical course observed, among pediatric patients with this condition. Results of the analysis were published in the journal Dermatologic Therapy.

Inclusion criteria for the articles selected were: studies that described the specific vascular skin lesion; studies that included patients older than 1 month to 18 years of age; and case reports, case series, retrospective or prospective cohort studies, and case-control studies. A total of 28 articles were included in the systematic review—11 from Italy, 6 from Spain, 6 from the United States, 3 from France, 1 from Germany, and 1 from Canada.  The total number of children with chilblain-like lesions was 433. The mean patient age was 12.58±21.5 years; 53.6% of the participants were male.

The incidence of chilblain-like cutaneous lesions during the COVID-19 pandemic was higher than anticipated when compared with the previous year, the researchers noted. The lesions most commonly involved the feet, particularly the toes, and were observed less often on the heels and the hands. Although the lesions were typically asymmetric, more than 1 lesion was usually present in a single patient, with the lesions persisting for less than 1 week to as long as 3 months.

Among the children presenting with chilblain-like cutaneous lesions, their nasopharyngeal SARS-CoV-2 reverse transcription polymerase chain reaction (RT-PCR) tests and anti-SARS-CoV-2 antibodies were mostly negative for COVID-19. Most of the patients did not have any personal or family history of autoimmune connective tissue disorder, Raynaud phenomenon, or prior similar chilblain-like cutaneous lesions. Some of the studies, however, reported a history of autoimmune disorders (in 15% of the children) or the presence of a positive personal or familial history of chilblain-like lesions (in 25% of the patients).

There may be some overlap in included patients, and some studies had incomplete medical history data, the investigators noted as limitations to the study.

The investigators concluded that recognition of chilblain-like lesions as a possible cutaneous presentation in asymptomatic children with COVID-19 is important, along with isolating the affected children “to prevent the silent spreading” of the virus to others, particularly high-risk individuals.


Molaee H, Emadi SN, M’Imunya JMN, Davoudi-Monfared, Mohammed A, Razavi Z. Chilblain or perniosis-like skin lesions in children during the COVID-19 pandemic: a systematic review of articles. Dermatol Ther. Published online January 3, 2022. doi:10.1111/dth.15298