Chilblains and COVID-19: why SARS-CoV-2 endothelial infection is questioned

Abstract

Recently, Colmenero et al (1) demonstrated, by immunohistochemistry, the presence of SARS‐CoV‐2 in endothelial cells of skin biopsy specimens of chilblains in seven patients. These results raise some questions: The presence of the virus at cutaneous and vascular levels in otherwise asymptomatic patients with negative RT‐PCR is unexpected. Vascular damage by direct viral effect is expected to be a sign of severity. It is also surprising that only feet are affected.