{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T07:27:34Z","timestamp":1780471654898,"version":"3.54.1"},"reference-count":29,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2022,10,19]],"date-time":"2022-10-19T00:00:00Z","timestamp":1666137600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100014607","name":"Royal Children's Hospital Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100014607","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>The COVID-19 pandemic has caused widespread illness with varying clinical manifestations. One less-commonly-reported presentation of COVID-19 infection is chilblain-like lesions. We conducted an ecological analysis of chilblain presentations in comparison with confirmed and suspected COVID-19 infections in a primary care setting to establish that a relationship exists between the two. Our study collated data from three Primary Health Networks across Victoria, Australia, from 2017\u20132021, to understand patterns of chilblain presentations prior to and throughout the pandemic. Using a zero-inflated negative binomial regression analysis, we estimated the relationship between local minimum temperature, COVID-19 infections and the frequency of chilblain presentations. We found a 5.72 risk ratio of chilblain incidence in relation to COVID-19 infections and a 3.23 risk ratio associated with suspected COVID-19 infections. COVID-19 infections were also more strongly associated with chilblain presentations in 0-16-year-olds throughout the pandemic in Victoria. Our study statistically suggests that chilblains are significantly associated with COVID-19 infections in a primary care setting. This has major implications for clinicians aiming to diagnose COVID-19 infections or determine the cause of a presentation of chilblains. Additionally, we demonstrate the utility of large-scale primary care data in identifying an uncommon manifestation of COVID-19 infections, which will be significantly beneficial to treating physicians.<\/jats:p>","DOI":"10.1371\/journal.pgph.0000488","type":"journal-article","created":{"date-parts":[[2022,10,19]],"date-time":"2022-10-19T13:29:42Z","timestamp":1666186182000},"page":"e0000488","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":6,"title":["Snotwatch COVID-toes: An ecological study of chilblains and COVID-19 diagnoses in Victoria, Australia"],"prefix":"10.1371","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7839-3527","authenticated-orcid":true,"given":"Rana","family":"Sawires","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Pearce","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0811-4785","authenticated-orcid":true,"given":"Michael","family":"Fahey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7594-0361","authenticated-orcid":true,"given":"Hazel","family":"Clothier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karina","family":"Gardner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jim","family":"Buttery","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,10,19]]},"reference":[{"issue":"1","key":"pgph.0000488.ref001","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1111\/bjd.19163","article-title":"Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases","volume":"183","author":"C Galvan Casas","year":"2020","journal-title":"Br J Dermatol"},{"issue":"5","key":"pgph.0000488.ref002","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1007\/s40257-020-00558-4","article-title":"Cutaneous Manifestations of COVID-19: An Evidence-Based Review","volume":"21","author":"G Daneshgaran","year":"2020","journal-title":"Am J Clin Dermatol"},{"issue":"6","key":"pgph.0000488.ref003","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1111\/ijd.14937","article-title":"Chilblain-like lesions on feet and hands during the COVID-19 Pandemic","volume":"59","author":"N Landa","year":"2020","journal-title":"Int J Dermatol"},{"issue":"8","key":"pgph.0000488.ref004","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1001\/jamadermatol.2021.2120","article-title":"Epidemiologic Analysis of Chilblains Cohorts Before and During the COVID-19 Pandemic","volume":"157","author":"PE McCleskey","year":"2021","journal-title":"JAMA Dermatol"},{"key":"pgph.0000488.ref005","first-page":"12034754211004575","article-title":"Chilblain-Like Lesions (CLL) Associated With COVID-19 (\"COVID Toes\"): A Systematic Review","volume":"2021","author":"N Kashetsky","year":"2021","journal-title":"J Cutan Med Surg"},{"issue":"2","key":"pgph.0000488.ref006","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1024\/0301-1526\/a000838","article-title":"Chilblains","volume":"49","author":"A Nyssen","year":"2020","journal-title":"Vasa"},{"issue":"2","key":"pgph.0000488.ref007","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/j.mayocp.2013.09.020","article-title":"Clinical characteristics, etiologic associations, laboratory findings, treatment, and proposal of diagnostic criteria of pernio (chilblains) in a series of 104 patients at Mayo Clinic, 2000 to 2011","volume":"89","author":"JA Cappel","year":"2014","journal-title":"Mayo Clin Proc"},{"issue":"2","key":"pgph.0000488.ref008","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1016\/j.jaad.2020.05.109","article-title":"Pernio-like skin lesions associated with COVID-19: A case series of 318 patients from 8 countries","volume":"83","author":"EE Freeman","year":"2020","journal-title":"J Am Acad Dermatol"},{"issue":"6","key":"pgph.0000488.ref009","doi-asserted-by":"crossref","first-page":"e14229","DOI":"10.1111\/dth.14229","article-title":"Do we have serological evidences that chilblain-like lesions are related to SARS-CoV-2? 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