text: Pediatric COVID toes and fingers The emergence of the coronavirus disease 2019 COVID 19 worldwide pandemic has been associated with a new constellation of cutaneous features in children Among the unusual dermatologic presentations are the so called COVID toes inflammatory nodules of the feet and toes sometimes involving the hands and fingers These lesions mimic acral pernio the synonym being chilblains Unlike adult patients with COVID toes children are less likely to manifest symptomatic COVID 19 Although a few studies have found some linkage to COVID 19 through the serum IgA or IgG severe acute respiratory syndrome coronavirus 2 SARS CoV 2 spike protein other studies have no demonstrable linkage suggesting that barefoot children in cold weather develop such lesions It appears that the chilblain like lesions related to the period of the COVID 19 pandemic may reflect a brisk immune response portending a good prognosis and perhaps some form of innate immunity The possible need to screen for coagulopathy is unclear but this has been suggested in one report Until we fully understand the pattern of immune response to COVID 19 questions may persist as to how disease manifestations are linked to SARS CoV 2 exposures 