Introduction
During the outbreak of COVID-19 many skin manifestations have been reported, and among these, in very significant numbers, newly eruptions like vascular and peculiar pernio-like skin lesions have been described in observational studies11Piccolo V, Neri I, Filippeschi C et Al. 2020 Chilblain-like lesions during COVID-19 epidemic: a preliminary study on 63 patients J Eur Acad Dermatol Venereol. 2020 Apr 24. doi: 10.1111/jdv.16526,22Galván Casas C, Català A, Carretero Hernández G, et al. Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases [published online ahead of print, 2020 Apr 29]. Br J Dermatol. 2020;10.1111/bjd.19163. doi:10.1111/bjd.19163,33Nerea Landa, Marta Mendieta-Eckert et al. Chilblain-like lesions on feet and hands during the COVID-19 Pandemic. International Journal of Dermatology. 2020 doi: 10.1111/ijd.14937,44Recalcati S, Barbagallo T, Frasin LA, et al. Acral cutaneous lesions in the time of COVID-19 [published online ahead of print, 2020 Apr 24]. J Eur Acad Dermatol Venereol . 2020;10.1111/jdv.16533. doi:10.1111/jdv.16533.Pernio, also referred to as chilblains, is a rare inflammatory condition. Chilblains derives from two Old English words ”chill” (cold) and ”blegen” (sore). Most commonly, pernio affects acral skin and develops among susceptible individuals who are exposed to cold, the lesions usually appear in fall or winter and disappear in spring or early summer. It is typically idiopathic and acute, nevertheless chronic forms also exist55Whitman PA, Crane JS, Pernio (Chilblains) StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020-. 2019 Nov 4. The diagnosis of pernio is largely clinical and based on a thorough history and physical exam.  The differential diagnosis must exclude diseases that can often be confused with other forms of pernio or vasculitic processes like LES or other conditions for example Raynaud phenomenon, acrocyanosis, cryoglobulinemia, cold panniculitis and Interferonopathies. The prognosis of pernio is good with minimal chronic sequelae.Single or multiple erythematous, purplish, edematous lesions appear, accompanied by intense pain, itching, or burning. Usually, pernio affects the toes and dorsum of the proximal phalanges66Tamara D. Simon, MD et Al. Pernio in Pediatrics.Pediatrics. 2005 Sep;116(3):e472-5.. Since March 2020, children with red and painful skin lesions, referable to chilblain have come to our attention. The injuries occurred in children and adolescents, however, in good health conditions, with suggestive history and established contact with SARS CoV2 patients. The increase in the number of cases of chilblain-like lesions compared to the cases with which we come into contact in our clinical practice every year, in association with the mild temperatures observed in those months in Southern Italy and the concomitant lockdown, led us to hypothesize a possible correlation with SARS Cov2 infection, so, the aim of the study is to evaluate this.