Figure 2.

Pernio in a male patient. A man who was in his 70s was evaluated in Florida in February 2020. He reported a few intermittent flares of an inflamed lesion, which affected only the long finger of the left hand. He had no history of pernio, cold exposure, autoimmune disease, travel history, or testing for coronavirus disease 2019 (COVID-19). He presented the week before the first positive case of COVID-19 was confirmed in Florida,¹ so an association with COVID-19 is unlikely, unless unrecognized community spread had occurred. A, Clinical photograph of the left hand illustrates an erythematous edematous plaque with focal vesiculation affecting the long finger of the left hand. Courtesy of James B. Connors, MD, BayCare Medical Group, Sun Coast Medical Clinic Dermatology, Saint Petersburg, FL; used with permission. B-F, Histopathologic sections of the patient’s punch biopsy specimen (hematoxylin-eosin) illustrate a superficial and deep dermal lymphocytic inflammatory infiltrate (panel B; original magnification, ×40); brisk perivascular inflammation in the superficial to mid dermis (panel C; original magnification, ×100); lichenoid interface dermatitis along the dermal-epidermal junction with basal vacuolar changes (panel D; original magnification, ×200); perieccrine lymphocytic inflammation at the junction of the deep reticular dermis and the subcutaneous adipose tissue (panel E; original magnification, ×200); and focal lymphocytic vasculitis involving a small dermal vessel, with endothelial swelling and extravasation of red blood cells into the surrounding dermis (panel F; original magnification, ×400).