This paper reports 38 cases of children who were referred to the Unit of Dermatology at Ospedali Riuniti Hospital in Foggia (Italy) for the development of acral skin lesions in March 2020. According to recent literature, nasopharyngeal swabs were performed on all children, with negative results; so, the swabs were not performed to their parents, also because they were all asymptomatic and negative for COVID-19 triage criteria. Of note, three were also observed among siblings within 2-3-weeks. The lesions involved predominantly the feet (one or both), while hands and other distal sites (such as ears) were only occasionally affected. In sum, multifocal and asymmetric purpuric-ecchymotic and/or "pernio-like" lesions were the leading feature of such clinical scenario. Ecchymotic lesions with scanty petechiae were observed on the sole, heel and/or plantar aspect of single toes. "Pernio-like" lesions with red-bluish erythematous patches were observed on dorsal aspect of toes, sometimes evolving into superficial skin vesiculo-bullous swelling and erosion. The management of these skin lesions might include the application of a topical association of corticosteroid and antibiotic to speed up the healing process. Anyway, self-healing is also possible. Mild dyschromic sequelae are usually observed. Our patients underwent therapy with a combined steroid and antibiotic cream with complete resolution after about 2-weeks.