By April 2020 it emerged that around half of the patients who presented with dermatological manifestations of coronavirus disease had so-called "COVID toes".[8] COVID toes are pinkish-reddish lesions that can turn purple as the coronavirus disease progresses (akin to pernio or chilblains),[12] but are distinct from purpura fulminans.[8][13] They typically last for two to three weeks and can without specific treatment.[14] The physiology behind COVID toes is not understood, but could occur due to inflammation of the toe tissue, inflammation of the blood vessel wall or small blood clots on the inside of the blood vessel.[8][15] Freeman has shown that even asymptomatic carriers can present with COVID toes, and that most patients in the dermatological register with COVID toe are in their 20s and 30s.[8] She has said that if people have these symptoms have no other cause to have such toes, they should try and get a COVID-19 test.[16][17] Lindy Fox, a dermatologist in San Francisco, reported that despite it not being the right time of year for chilblains, she was seeing "clinics filled with people coming in with new toe lesions".[17]