• Jean Kanitakis, Cécile Lesort, Marie Danset, and Denis Jullien.
• Department of Dermatology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France; Department of Anatomic Pathology, Lyon Sud Hospital Center, Pierre Bénite, France. Electronic address: jean.kanitakis@univ-lyon1.fr.
• J. Am. Acad. Dermatol. 2020 Sep 1; 83 (3): 870-875.

BackgroundDuring the coronavirus disease 2019 pandemic, several acral chilblain-like lesions were observed in young patients with suspected, but mostly unconfirmed, infection with severe acute respiratory syndrome coronavirus 2. The histopathologic aspect of these lesions is as yet poorly known.ObjectiveTo investigate the pathologic features of chilblain-like lesions.MethodsBiopsies were obtained from 17 cases of chilblain-like lesions during the coronavirus disease 2019 pandemic in France and were studied by routine histologic examination, immunohistochemistry, and direct immunofluorescence. The patients had suspected but unconfirmed infection with severe acute respiratory syndrome coronavirus 2 (negative nasopharyngeal polymerase chain reaction and serologic test results).ResultsChilblain-like lesions showed many features in common with those reported in idiopathic and autoimmune-related chilblains, including epidermal necrotic keratinocytes, dermal edema, perivascular and perieccrine sweat gland lymphocytic (predominantly CD3/CD4+) inflammation, and frequent vascular changes (endothelialitis, microthromboses, fibrin deposition, and immunoreactant deposits on vessels).ConclusionsChilblain-like lesions show histopathologic features similar to those of idiopathic and autoimmune-related chilblains, with a high rate of vascular changes and direct immunofluorescence positivity. The role of severe acute respiratory syndrome coronavirus 2 in the development of these puzzling lesions remains to be elucidated.Copyright © 2020 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

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