Acute Vascular Reactive Inflammatory Acral Skin Lesions and SARS-CoV-2

Keywords: COVID-19, Chilblains, Nail Diseases, Paronychia, SARS-CoV-2, Skin Diseases


Introduction: Coronavirus disease 2019 (COVID-19) predominantly affects the respiratory system, but there have been many reports of skin involvement. Several cutaneous manifestations associated with COVID-19 have been identified, including acral lesions (pernio-like), which we intend to better characterize in this study.

Methods: Demographic, clinical and major histopathologic characteristics of acral skin lesions occurring during the acute infection stage of COVID-19 disease were evaluated in this survey conducted in the Dermatology Division of Santa Casa Hospital Complex, Federal University of Health Sciences, Porto Alegre, Brazil.

Results: In the present study, we evaluated eight female patients with acute SARS-CoV-2 infection confirmed by PCR with acral skin lesions including pernio-like. The mean age was 43.6 and with no other acute disease, who had a good outcome with need for hospitalization only in 2 cases. Pernio-like lesions were observed under hot weather conditions in patients who denied any previous history of similar cutaneous manifestations. Some acral lesions resembled those of lupus erythematosus and of herpes simplex paronychia, but laboratory tests were negative for those conditions. Unusual nail involvement was present, characterized by half-moon shaped erythematous bands at the distal margin of the lunula.

Conclusion: Recognition of these skin lesions is important in that they could be potential markers, aiding in the diagnosis and prognosis of COVID-19 disease.


Download data is not yet available.


Jindal R, Chauhan P. Cutaneous manifestations of coronavirus disease 2019 in 458 confir- med cases: A systematic review. J Fam Med Prim Care. 2020;9:4563. doi: 10.4103 / jfmpc. jfmpc_872_20

Naderi-Azad S, Vender R. Lessons From the First Wave of the Pandemic: Skin Features of COVID- 19 can be Divided Into Inflammatory and Vascular Patterns. J Cutan Med Surg. 2021;25:169- 76. doi: 10.1177/1203475420972343

Kaya G, Kaya A, Saurat J-H. Clinical and Histopathological Features and Potential Patholo- gical Mechanisms of Skin Lesions in COVID-19: Review of the Literature. Dermatopathology. 2020;7:3–16. doi: 10.3390/dermatopathology7010002

Criado PR, Abdalla BM, de Assis IC, Graaff Mello C, Caputo GC, Vieira IC. Are the cuta- neous manifestations during or due to SARS-CoV-2 infection/COVID-19 frequent or not? Revi- sion of possible pathophysiologic mechanisms. Inflamm Res. 2020;69:745–56. doi: 10.1007 / s00011-020-01370-w

Carrascosa JM, Morillas V, Bielsa I, Munera-Campos M. Cutaneous Manifestations in the Context of SARS-CoV-2 Infection (COVID-19). Actas Dermosifiliogr. 2020;111:734-42. doi: 10.1016/

Galván Casas C, Català A, Carretero Hernández G, Rodríguez-Jiménez P, Fernández-Nieto D, Rodríguez-VillaLario A, et al. Classification of the cutaneous manifestations of COVID- 19: a rapid prospective nationwide consensus study in Spain with 375 cases. Br J Dermatol. 2020;183:71–7. doi: 10.1111/bjd.19163

Daneshgaran G, Dubin DP, Gould DJ. Cutaneous Manifestations of COVID-19: An Evidence- -Based Review. Am J Clin Dermatol. 2020;21:627-39. doi: 10.1007/s40257-020-00558-4.

Fernandez-Nieto D, Jimenez-Cauhe J, Suarez-Valle A, Moreno-Arrones OM, Saceda-Corralo D, Arana-Raja A, et al. Characterization of acute acral skin lesions in nonhospitalized patients: A case series of 132 patients during the COVID-19 outbreak. J Am Acad Dermatol. 2020;83:e61– 3. doi: 10.1016/j.jaad.2020.04.093

Bouaziz JD, Duong TA, Jachiet M, Velter C, Lestang P, Cassius C, et al. Vascular skin symptoms in COVID-19: a French observational study. J Eur Acad Dermatology Venereol. 2020;34:e451–2. doi: 10.1016/j.jaad.2020.05.109

Cappel JA, Wetter DA. Clinical characteristics, etiologic associations, laboratory findings, treat- ment, and proposal of diagnostic criteria of pernio (chilblains) in a series of 104 patients at Mayo Clinic, 2000 to 2011. Mayo Clin Proc. 2014;89:207-15. doi: 10.1016/j.mayocp.2013.09.020.

Freeman EE, McMahon DE, Lipoff JB, Rosenbach M, Kovarik C, Takeshita J, et al. Pernio-like skin lesions associated with COVID-19: A case series of 318 patients from 8 countries. J Am Acad Dermatol. 2020;83:486–92. doi: 10.1016/j.jaad.2020.05.109

Docampo-Simón A, Sánchez-Pujol MJ, Juan-Carpena G, Palazón-Cabanes JC, Vergara-De Caso E, Berbegal L, et al. Are chilblain-like acral skin lesions really indicative of COVID-19? A prospective study and literature review. J Eur Acad Dermatology Venereol. 2020;34:e445–7. doi: 10.1111/jdv.16665

Duong TA, Velter C, Rybojad M, Comte C, Bagot M, Sulimovic L, et al. Did Whatsapp® reveal a new cutaneous COVID-19 manifestation? J Eur Acad Dermatology Venereol. 2020;34:e348– 50. doi: 10.1111/jdv.16534

Andina D, Noguera-Morel L, Bascuas-Arribas M, Gaitero-Tristán J, Alonso-Cadenas JA, Escala- da-Pellitero S, et al. Chilblains in children in the setting of COVID-19 pandemic. Pediatr Derma- tol. 2020;37:406–11. doi: 10.1111/pde.14215

Colonna C, Genovese G, Monzani NA, Picca M, Boggio F, Gianotti R, et al. Outbreak of chil- blain-like acral lesions in children in the metropolitan area of Milan, Italy, during the COVID-19 pandemic. J Am Acad Dermatol. 2020;83:965–9. doi: 10.1016 / j.jaad.2020.06.019

Neri I, Guglielmo A, Virdi A, Gaspari V, Starace M, Piraccini BM. The red half-moon nail sign: a novel manifestation of coronavirus infection. J Eur Acad Dermatol Venereol. 2020;34:e663–5. doi:10.1111/jdv.16747

Recalcati S, Barbagallo T, Frasin LA, Prestinari F, Cogliardi A, Provero MC, et al. Acral cuta- neous lesions in the time of COVID-19. J Eur Acad Dermatol Venereol. 2020;34:e346–7. doi:10.1111/jdv.16533

Santonja C, Heras F, Núñez L, Requena L. COVID-19 chilblain-like lesion: immunohistochemi- cal demonstration of SARS-CoV-2 spike protein in blood vessel endothelium and sweat gland epithelium in a polymerase chain reaction-negative patient. Br J Dermatol. 2020;183:778-80. doi: 10.1111/bjd.19338

Gambichler T, Reuther J, Stücker M, Stranzenbach R, Torres-Reyes C, Schlottmann R, et al. SARS- -CoV-2 spike protein is present in both endothelial and eccrine cells of a chilblain-like skin le- sion. J Eur Acad Dermatol Venereol. 2021;35:e187-9. doi: 10.1111/jdv.16970

Genovese G, Moltrasio C, Berti E, Marzano AV. Skin Manifestations Associated with COVID- 19: Current Knowledge and Future Perspectives. Dermatology. 2021;237:1–12. doi: 10.1159/000512932

How to Cite
Minotto, R., R. Fitz, J., M. Bauer, B., & Choi, A. H. (2021). Acute Vascular Reactive Inflammatory Acral Skin Lesions and SARS-CoV-2. Journal of the Portuguese Society of Dermatology and Venereology, 79(4), 315-320.
Original Articles