I would like to share ideas on the report on “Lesiones pernióticas y acrales en España durante el confinamiento por COVID: análisis retrospectivo de 12 casos” with a great interest.1 El Romaní et al. noted that Como conclusión, este sorprendente cuadro clínico es atípico porque ha aparecido durante el clima cálido, no asociado con la perniosis común y, aunque tiene una relación temporal con la pandemia de COVID, en ninguno de los pacientes hay evidencia demostrable de infección por COVID-19 actual o pasada.1 “Regarding the present report by Romaní et al.,1 it should performed additional study to rule out other possible causes of skin lesion such as other concurrent virus infection. In fact, Chilblain and Acral Purpuric Lesions are new emerging dermatological conditions that are reported from many countries although there is a lack of report from tropical zone.2,3 The new evidences show that there might be an association with COVID-19. The identification of immunoglobulin to SARSCoV2 in some patients becomes the clue for further study on dermatopathophysiology of chilblain and acral purpuric lesions in COVID-19.4