Pernio-like skin lesions associated with COVID-19: A case series of 318 patients from 8 countries

J Am Acad Dermatol. 2020 Aug;83(2):486-492. doi: 10.1016/j.jaad.2020.05.109. Epub 2020 May 30.


Background: Increasing evidence suggests pernio-like lesions are cutaneous manifestations of coronavirus infectious disease 2019 (COVID-19).

Objective: To describe clinical and pathologic findings of pernio-like lesions in patients with confirmed or suspected COVID-19.

Methods: An international dermatology registry was circulated to health care providers worldwide through the American Academy of Dermatology, International League of Dermatologic Societies, and other organizations.

Results: We documented 505 patients with dermatologic manifestations associated with COVID-19, including 318 (63%) with pernio-like lesions. Patients with pernio-like lesions were generally young and healthy, with relatively mild COVID-19. Of 318 patients with confirmed or suspected COVID-19 by providers, 23 (7%) were laboratory-confirmed COVID-19 positive, and 20 others (6%) were close contacts of patients with confirmed COVID-19. Given current testing criteria, many patients lacked COVID-19 testing access. For 55% of patients, pernio-like lesions were their only symptom. In patients with other COVID-19 symptoms, pernio-like lesions typically appeared after other symptoms. Pernio-like lesions lasted a median of 14 days (interquartile range, 10-21 days).

Limitations: A case series cannot estimate population-level incidence or prevalence. In addition, there may be confirmation bias in reporting. We cannot exclude an epiphenomenon.

Conclusions: Pernio-like skin changes of the feet and hands, without another explanation, may suggest COVID-19 infection and should prompt confirmatory testing.

Keywords: COVID-19; chilblains; dermatology; pernio; public health.

MeSH terms

  • Adolescent
  • Adult
  • Betacoronavirus / isolation & purification*
  • Bias
  • COVID-19
  • COVID-19 Testing
  • Chilblains / diagnosis
  • Chilblains / epidemiology
  • Chilblains / virology*
  • Clinical Laboratory Techniques
  • Coronavirus Infections / complications*
  • Coronavirus Infections / diagnosis
  • Coronavirus Infections / virology
  • Female
  • Foot
  • Hand
  • Humans
  • Male
  • Middle Aged
  • Pandemics
  • Pneumonia, Viral / complications*
  • Pneumonia, Viral / diagnosis
  • Pneumonia, Viral / virology
  • Registries / statistics & numerical data
  • SARS-CoV-2
  • Severity of Illness Index
  • Skin Diseases / diagnosis
  • Skin Diseases / epidemiology
  • Skin Diseases / virology*
  • Time Factors
  • Young Adult