Are Chilblain-Like Lesions Related to COVID-19?

Chilblain (Photo By BSIP/UIG Via Getty Images)
A series of 10 patients presenting chilblain-like lesions during the peak of the pandemic and examined for evidence of SARS-CoV-2 infection is described.

SARS-CoV-2 infection cannot be demonstrated to directly induce the recently observed outbreak of unusual chilblain lesions during the coronavirus-19 (COVID-19) pandemic, according to study findings published in the Journal of the European Academy of Dermatology and Venereology.

Despite climatic conditions not conducive to the development of chilblains, an outbreak was observed by dermatologists throughout March and April of 2020. The coincidence of this outbreak with the COVID-19 epidemic suggests a potential relationship between the chilblains onset and infection with SARS-CoV-2.

To determine if there is a relationship between the recent chilblains outbreak and that of COVID-19, data from 10 patients (50% women) presenting with chilblain-like lesions were analyzed. The median age of participants was 33 years. No patients had contact with a confirmed COVID-infected person.

Two biopsies were performed on lesioned skin for diagnosis and for SARS-CoV-2 testing. An additional nasopharyngeal swab was collected for SARS-CoV-2 testing using RT-PCR. All blood samples were normal except 3 patients who had positive antinuclear antibodies with antinucleolar or anticentromere patterns. No SARS-CoV-2 infection or antibodies were detected.

As the study authors concluded, their data “do not confirm a direct role of SARS-CoV-2 or an immunological hit-and-run mechanism.” Instead, they suggest that some of the patients who presented with chilblain-like lesions “might have an authentic systemic disease, fortuitously detected.


Rouanet J, Lang E, Beltzung F, et al. Recent outbreak of chilblain-like lesions is not directly related to SARS-CoV-2 infection. [published online June 26, 2020]. JEADV. doi:10.1111/jdv.16776