Chilblain-like lesions after BNT162b2 mRNA COVID-19 vaccine: a case report suggesting that 'COVID toes' are due to the immune reaction to SARS-CoV-2.

Several skin manifestations have been described in association with the COVID-19 pandemic since March 2020. Acral chilblain-like lesions (CBLL), usually referred to as "COVID-toes", are among the most common and characteristic ones, even though the direct causative role of SARS-CoV-2 has been debated. Indeed, although some authors have reported the detection of SARS-CoV-2 within the lesions with immunohistochemistry and electron-microscopy (1, 2), the majority of patients with CBLL have had negative tests for SARS-CoV-2 (including serological tests and nasopharyngeal and in situ-skin PCR) (3).