A 28-year-old woman developed erythema, swelling, pain, and pruritus on the dorsal aspect of her toes bilaterally (Fig. 1A). During the 3 weeks that followed, these lesions progressively became more painful, developed vesicles, became dusky purple-red in color, and eroded superficially (Fig. 1B and C). The patient tried an over-the-counter antifungal medication without improvement. Two weeks before the onset of thetoe discoloration, the patient had experienced 3 days of low-grade fever and malaise. She was otherwise healthy.
Among the cutaneous manifestations described during the coronavirus disease 2019 (COVID-19) pandemic, pseudo-chilblains, or 'COVID toes', has been the most common (Freeman et al., 2020a). In contrast to chilblains (also called pernio), which classically is associated with cold temperatures, the erythrocyanotic acral lesions of pseudo-chilblains have presented in the spring and even mid-summer and in warm climates.