Going viral: A brief history of Chilblain-like skin lesions (COVID toes) amidst the COVID-19 pandemic

Abstract Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of the respiratory illness COVID-19, has led to a global pandemic. In a rapidly evolving medical literature its manifestations are expanding and now include coagulopathies renal dysfunction, cardiac arrests, multisystem inflammatory syndrome in children as well as cutaneous manifestations commonly observed with viral illnesses and chilblain-like skin lesions often referred to as “COVID toes”. Driven in large part by the internet-facilitated communication, dermatologists around the world now report a marked increase in the frequency of chilblain-like diagnoses, not infrequently in members of the same family, amidst the COVID-19 pandemic. While a mechanistic explanation has yet to be proven a robust antiviral immune response in young patients that simultaneously truncates the clinical course and induces the microangiopathic changes could lead to chilblain-like skin lesions. This or a similar explanation would then posit that chilblain-like lesions would be most likely to appear only after a successful viral response is mounted with lesions detected only when symptoms are likely to be subsiding. We review the rapid evolution of the chilblain-like presentation in patients with COVID 19 beginning with its first description in early March 2020 and summarize the evolving but rapidly self-confirming data.