Chilblain-like lesions have been reported in some patients with positive tests for the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the COVID-19 pandemic, but the relationship between these lesions and COVID-19 remains unclear, according to research findings published in the Journal of the European Academy of Dermatology and Venereology.

The research was a systematic review and meta-analysis of 63 studies that reported chilblain-like lesions in individuals with positive polymerase chain reaction (PCR) and/or serology tests for SARS-CoV-2 or a clinical suspicion of COVID-19. In total, the studies reported a pooled chilblain-like lesion case count of 2919. Patients included 1092 women and 1200 men with ages ranging from 0 to 100 years (mean age, 20.9 years). Of all patients with chilblain-like lesions, a total of 1154 underwent PCRs, and 943 underwent serology testing.

Overall, the pooled COVID-19 prevalence was 2.6% (95% CI, 1.9-3.4) in patients with chilblain-like lesions and positive PCR tests as well as 7.2% (95% CI, 4.7–10.2%) in those with positive serology for SARS-CoV-2. In the subgroup who were tested for COVID-19, the pooled COVID-19 prevalence rates were 5.5% (95% CI, 3.7–7.7%) for positive PCR tests and 11.8% (95% CI, 7.9–16.3%) in patients with positive serology for SARS-CoV-2.

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The pooled prevalence rate of patients with chilblain-like lesions who were diagnosed with COVID-19 by a positive PCR and/or serology test was 15.2% (95% CI, 10.4–20.7%), and the pooled prevalence of positive PCRs and/or serologies in patients with the lesions was 7.5% (95% CI, 5.1–10.3%).

The researchers noted that there was high between-study heterogeneity, which may limit the findings of the meta-analysis. In addition, many of the sample sizes of the included studies were small, which may further limit the generalizability of the results.

“There is a need for further studies of high methodological quality that perform serological tests for COVID-19 that are sufficiently sensitive and specific as well as correctly timed in order to detect a possible seroconversion,” the researchers wrote.


Sánchez-García V, Hernández-Quiles R, de-Miguel-Balsa E, et al. Are the chilblain-like lesions observed during the COVID-19 pandemic due to severe acute respiratory syndrome coronavirus 2? Systematic review and meta-analysis. J Eur Acad Dermatol Venereol. Published online September 21, 2021. doi:10.1111/jdv.17672

This article originally appeared on Dermatology Advisor