• Christine J Ko, Malini Harigopal, William Damsky, Jeff R Gehlhausen, Marcus Bosenberg, Robert Patrignelli, and Jennifer M McNiff.
• Department of Dermatology, Yale Department of Dermatology, Yale University, New Haven, Connecticut, USA.
• J. Cutan. Pathol. 2020 Nov 1; 47 (11): 997-1002.

BackgroundAcral inflammatory lesions that have some resemblance to idiopathic or autoimmune-associated perniosis (chilblains) have been described in multiple countries during the COVID-19 pandemic.MethodsWe examined histopathologic findings in six consecutive such cases from five patients received in mid-May to mid-June of 2020, evaluating immunohistochemical staining for the SARS-CoV-2 nucleocapsid protein. We compared these six cases to eight cases diagnosed as perniosis between January and June of 2019.ResultsFive of six lesions with perniosis-like histopathology during the COVID-19 pandemic had distinctive tight cuffing of lymphocytes; intravascular material was present in one case. SARS-CoV-2 immunohistochemical staining using an antibody directed at the nucleocapsid protein was negative in all six cases. Only one of eight specimens with microscopic findings of perniosis received prior to the COVID-19 pandemic had tightly cuffed perivascular lymphocytes, and none had obvious intravascular occlusion.ConclusionsA tightly cuffed pattern of perivascular lymphocytes is a feature of perniosis during the COVID-19 pandemic. The absence of SARS-CoV-2 nucleocapsid protein in these cases suggests against the virus being directly present in these lesions.© 2020 John Wiley & Sons A/S . Published by John Wiley & Sons Ltd.

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