Document Type : Review Article


1 Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

2 Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

3 Dermatology Department, Shiraz University of Medical Sciences, Shiraz, Iran


The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of the coronavirus disease 2019 (COVID-19) pandemic and possesses a tropism for multiple organs.
In this systematic review, we put together all relevant papers to assess the link between COVID-19 infection and acral lesions (particularly chilblain-like lesions) and to determine whether these lesions can be put together in a spectrum of manifestations.
Skin manifestations of COVID-19 vary, ranging from mostly acral chilblain-like, livedoid lesions or ischemia and necrosis to vesicular eruptions, maculopapular lesions, urticaria, oral or periorbital lesions, and drug eruptions.
A great deal of scientific evidence have focused on the peculiar erythematous and purpuric violaceous acral
lesions in young and healthy individuals resembling chilblains (pernio), leading the scientific community to investigate the association between these lesions and SARS-CoV-2. Furthermore, this is suggestive that some COVID-19 skin manifestations like livedo reticularis and acral ischemia and necrosis might share
dermatopathologic features with thrombophilic states.