To select keywords, we selected commonly used search terms related to chilblain-like lesions, such as “toe” or “frostbite,” in order to retrieve queries made by the general population. We did not include “finger,” since excessive use of sanitizers during the pandemic resulted in irritation and contact dermatitis. Furthermore, we measured searches of medical terms such as “chilblains” using both the singular and plural forms of the search term. We did not take misspellings into account. Since “toe” can be used in different contexts, we restricted our searches to the “health” category. We used quotation marks for queries including strings of >2 words (eg, “dedo del pie” in Spanish). Search strings included a combination of these terms with the “+” operator denoting the ”OR” logical function (Table 1). “Coronavirus” and “COVID-19” were searched in a separate query, also restricted to the “health” category.

Search inputs, date of lockdown enforcement, and date of the initial press release on acral lesions in France, Spain, Italy, Germany, the United Kingdom, and the United States.

aIn the United States, we chose March 21 as the date of lockdown enforcement, since this date differed among states: California, March 19; Illinois, New Jersey, and New York, March 22; Ohio, March 23.

We included high-income countries whose populations are familiar with search engines and where Google is the leading search engine. Furthermore, we included countries with different government responses to the pandemic and different announcements related to chilblain-like lesions, including the United States, the United Kingdom, Spain, Italy, France, and Germany. We translated the search terms in the five languages (English, French, Spanish, Italian, and German) using both internet-based translators and support from native speakers.

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