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Paraviral eruptions in the era of COVID-19: Do some skin manifestations point to
a natural resistance to SARS-CoV-2?
#MMPMID33341210
Lipsker D
Clin Dermatol
2020[Nov]; 38
(6
): 757-761
PMID33341210
show ga
Paraviral eruptions, such as the papular-purpuric gloves and socks syndrome or
eruptive pseudoangiomatosis, share the following features that distinguish them
from a classic viral eruption: they are highly recognizable; the eruption usually
lasts a few weeks; many different viruses and sometimes other agents can trigger
them; on microscopic examination, there is no specific cytopathogenic viral
effect. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can induce
both a classic viral eruption and a paraviral eruption, the meaning of which in
terms of pathophysiology and prognosis is very different. Some patients infected
with coronavirus disease 2019 (COVID-19) have a papulovesicular eruption
involving mainly the trunk. Those patients have active viremia, and some have
developed pneumonia and died. Biopsy of the eruption revealed cytopathogenic
viral effect, and thus there is a direct interaction of the virus with the skin;
it is, therefore, a classic viral exanthema. Others, mainly young patients,
developed chilblains of the fingers and toes 3 or 4 weeks after minor signs of
COVID-19 or after contact with a diseased person. They did not develop severe
COVID-19. Biopsy revealed classic findings of chilblains without cytopathogenic
viral effect. Most of those patients did not develop specific antibodies. Those
chilblains can be considered as paraviral. Classic viral manifestations are the
consequence of a direct interaction of the skin with the virus, whereas paraviral
manifestations result from the activation of the immune system. In the case of
paraviral chilblains, I hypothesize that it is the innate immune system that
rejects SARS-CoV-2. Chilblains are also observed in rare monogenic disorders
called type 1 interferonopathies, where antiviral innate imunity is abormally
activated. This would explain why these individuals do not develop specific
antibodies, because they are probably naturally resistant to SARS-CoV-2 infection
via their innate immuen system.
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