key: cord-304330-egvdvvtx
authors: Damsky, William; Peterson, Danielle; King, Brett
title: When interferon tiptoes through COVID-19: Pernio-like lesions and their prognostic implications during SARS-CoV-2 infection
date: 2020-06-19
journal: J Am Acad Dermatol
DOI: 10.1016/j.jaad.2020.06.052
sha: 
doc_id: 304330
cord_uid: egvdvvtx

nan

William Damsky MD, PhD 1,* , Danielle Peterson MD 1 Brett King MD, PhD 1,* 4 5 has suggested that SARS-CoV-2 infection is sometimes characterized by a muted anti-40 viral Type I and III interferon (IFN) response, 6,7 which may explain progression to 41 severe clinical manifestations in some patients; a robust Type I IFN response was 42 associated with rapid viral clearance and bland disease course. 6 Here, we describe 43 pernio-like lesions as they have been reported in the literature and consider other 44 settings where pernio is observed, including familial chilblains lupus, an 45

Interferonopathy syndrome. Together, these data suggest that COVID toes may be a 46 marker of patients that are able to mount a robust anti-viral immune response to SARS-CoV-2 and prognosticate a milder course of COVID-19. 48

Sporadic pernio (also known as chilblains) is an idiopathic cold-sensitive inflammatory 50 disorder that presents with red-to-violaceous macules or papules on acral sites; 51 vesiculation and ulceration may occur. These lesions are typically located on the distal 52 toes, but can also occur on fingers, heels, and even the nose and ears. Histopathology 53 reveals edema in the superficial dermis and marked superficial and deep perivascular 54 and peri-eccrine lymphocytic inflammation (Figure 1A) . Interface change and/or 55 vasculopathic changes (e.g. focal thrombosis) may be present. Type I IFN response is associated with early viral control and a mild course, while an 79 insufficient Type I IFN response may be associated with progression to more severe 80 disease ( Figure 1B) . 6,7 Therefore, we hypothesize that pernio-like lesions, which can 81 occur with elevated Type I IFN signaling, are the result of a robust anti-viral response in patients with COVID-19, and, therefore, are associated with a favorable disease course, 83 as observed in these patients. 

Characterization of 87 acute acro-ischemic lesions in non-hospitalized patients: a case series of 132 88 patients during the COVID-19 outbreak

Chilblains in children in 91 the setting of COVID 19 pandemic

COVID-19) infection-94 induced chilblains: A case report with histopathologic findings

Classification of the 97 cutaneous manifestations of COVID 19: a rapid prospective nationwide 98 consensus study in Spain with 375 cases

Pernio-like skin lesions associated 101 with COVID-19: a case series of 318 patients from 8 countries

Type I IFN immunoprofiling in 104 COVID-19 patients

Imbalanced Host Response to