Perniosis/chilblains are the acral inflammatory skin lesions developing in susceptible individuals as an abnormal reaction to cold . In the absence of a discernible cause, it is labeled as idiopathic perniosis (IP). With the ongoing COVID-19 pandemic, there was an upsurge of reports of chilblain like lesions (CLL) especially in young patients possibly implicated to the SARS-CoV-2 virus . Twelve clinically suspected and histopathologically confirmed cases of IP seen from November 2019 through February 2020 were retrospectively recruited . Clinical, dermoscopic, and histopathological characteristics of these were reviewed and compared with CLL reported in the literature . Mean age of patients was 26.58 ± 15.18 years with an equal male to female ratio . Characteristic histopathology findings were spongiosis (100 %), dermal edema (100 %), perivascular lymphocytic infiltrate (100 %) with peri-eccrine accentuation (66.7 %), keratinocyte necrosis (50 %), focal basal vacuolar damage (58.3 %), and lymphocytic vasculitis (58.3 %). Significant dermoscopy findings were variable background color ranging from dull red and violaceous to copper red and brown orange, coiled vessels (44.4 %) and orange-red structureless areas (63.9 %). Lesions over palms and soles preferentially had white dots/clods and lines (38.9 %). There appears no exclusive histopathological as well as dermoscopy features of CLL and IP, yet certain clues can be appreciated . Keratinocyte necrosis and severe dermal edema favors IP, whereas fibrin thrombi with involvement of both superficial and deep dermal vessels favor CLL . Dermoscopically presence of irregular, linear or branching vessels, red/purple dots and clods and gray brown reticule supports CLL while white dots/clods and lines supports IP.
Index: COVID-19, Covid toes, chilblain like lesions, dermoscopy, idiopathic perniosis