Negative tests for SARS-CoV-2 infection do not rule out its responsibility for chilblains

We read with great interest the report of Le Cleach et al discussing chilblains as a manifestation of COVID-19 pandemic  They reported 311 patients with acral lesions occurring during the COVID-19 lockdown in France The most frequent clinical presentation of these acral lesions was typical chilblains Among the 150 patients with RT-PCR testing and/or serology, only 10 had confirmed COVID-19 They concluded that there is no evidence of SARS-CoV-2 infection in the large majority of patients with acral lesions They hypothesized that the situation could be due to the media stating that chilblains were caused by SARS-CoV-2 infection and leading to a higher rate of consultation or the lockdown leading to more inactivity and long periods at home barefoot on a cold floor