During the COVID-19 pandemic, many pathological cutaneous manifestations occurred before, during or after the viral infection. But many cases are complicated by systemic infections, evolving into a systemic inflammatory response and its vascular complications.The evolution to vascular conditions such as livedo, purpura and necrosis, associated with thromboembolic fenomenal, is late, more severe and has a worst prognosis.  Patient T.B., female, 30 years old, on January 15, 2020, we assisted a woman with violaceous erythema on the ends of her fingers. Her patological historic was her mother had hospitalized in October 2019, with severe lung disease, which was not explained. And her 23 years old sister presented with exuberante urticaria in October 2019, during the hospitalization of her mother and grandmother about severe lung disease nonspecifc. Everything happened before it was declare a pandemic COVID-19 in Brazil which the similar infections had happened endemic a long time ago without notification assertive especific in Brazil and the world and were underreported or not reported by the Ministry of Healh and WHO. The patient was not treated immediately diagnoses with Sars-cov 02 infection, and the severity of the skin lesions was evaluated by the dermatologista examination. The patient had a systemic inflammatory evolution with the worst erythema lesions on the hands and feet. She presented an increase in the time of illness and treatment. In this period of little information about the COVID-19 disease in Brazil, the pathophysiology of symptoms and many differents clinicals manifestations prevailed to guide diagnosis and treatment, with some pathological and epidemiological features not yet explained by more specif tests. Differential clinical diagnosis and subjective medical experience were essential in this practice to provide medical attention to define therapeutic solutions for healing and better clinical evolution about Erythema pernio with individual and collective quality of life.