Comment on “Chilblains‐like lesions in children following suspected COVID‐19 infection”

The publication entitled “Chilblains‐like lesions in children following suspected Covid‐19 infection” is very interesting. ¹ Colonna et al reported four children with suspected COVID‐19 cases noting that “[h]istology from one case showed signs of vasculitis with evident fibrin thrombus”. ¹ While various skin findings have been reported with COVID‐19 infection, the chilblains lesions have been reported from Italy and Spain, and sporadically from China, the starting point of disease pandemic. ² , ³ , ⁴ , ⁵

However, it should be noted that chilblains‐like lesions have not been reported from endemic areas in tropical regions (such as Southeast Asia and South America). For example, in our country, Thailand, we have not seen any patients presenting with this skin finding despite having over 3000 cases reported as of May 11, 2020. The rarity of chilblains‐like lesions in tropical countries suggests the importance of weather, particularly cold exposure, as a possible co‐factor for this vasculopathy noted in association with COVID‐19 infection. Pathophysiologically, chilblains can result from an excessive abnormal vascular response to cold that leads to cutaneous inflammation.