key: cord-0800193-51yry3w3
authors: Rodríguez‐Villa Lario, A; Vega‐Díez, D; González‐Cañete, M; Gómez‐Zubiaur, A; Pérez‐Mesonero, R; Bandini, M; Polo‐Rodríguez, I; Vélez‐Velázquez, D; Trasobares‐Marugán, L
title: Histological findings in chilblain‐lupus like COVID lesions: in search of an answer to understand their etiology
date: 2020-06-12
journal: J Eur Acad Dermatol Venereol
DOI: 10.1111/jdv.16733
sha: ad9be5df873a921e7d2e026abf7030385d6db3ef
doc_id: 800193
cord_uid: 51yry3w3

We read with great interest the article by Piccolo et al(1). describing chilblain‐like lesions (CLL) on feet and hands during the COVID‐19 Pandemic. They mention the rate of association to autoimmune conditions was very low, which led the to exclude a note autoimmune disorder as main cause of CLL. Here, we hypothesize the possible relationship between the development of these lesions and immune‐chained phenomena following viral infection in a certain group of patients.

autoimmune conditions was very low, which led the to exclude a note autoimmune disorder as main cause of CLL. Here, we hypothesize the possible relationship between the development of these lesions and immune-chained phenomena following viral infection in a certain group of patients.

Although perniosis is a frequent phenomenon, it seems reasonable to establish a causal relationship between these lesions and the coronavirus given the significant increase in these lesions in the epidemiological context that we are living in 1, 2 .

Kolivras et 3 al have recently described the histological manifestations in a 23-year-old caucasian male with pernicious lesions and a confirmed rt-PCR positive for COVID-19 without other analytical alterations.

We reaffirm the similarity between these lesions and those found in lupus chilblain. We present another case of an 17-year-old male, caregiver of a patient convalescing from COVID pneumonia, who presented acral lesions of two days' evolution compatible with the acromanifestations 

This article is protected by copyright. All rights reserved

The understanding of the molecular basis of innate immunity has led to identification of IFNs as a central mediator in the pathogenesis of systemic lupus erythematosus (SLE) 5 . Type I IFNs, produced mainly by plasmacytoid dendritic cells have been claimed important in the pathogenesis of SLE skin lesions. We propose that the detection of these subspecialized cells by immunochemistry with the CD 123 marker, as producers of IFN in skin, may help to understand the underlying pathophysiology.

The combination of these two facts could be responsible for the appearance of lupus-like lesions preferably in young patients.

We describe as well a dense and striking inflammatory infiltration in the vascular wall with tumefaction of the endothelial cells, without finding any fibrinoid necrosis nor microthrombi as discussed by Landa et al 6 . It has been already proven the existence of viral inclusion bodies and viral particles in endothelial cells and the detection of mononuclear cell infiltrates within the intima of vessels in different organs 7 . We propose that similar changes are responsible for the endothelitis observed in our skin specimen.

However, there are still unanswered questions, such as the delay in the appearance of the or why other skin lesions resembling lupus have not been described to date. Further research is needed to answer these questions. 

Chilblain-like lesions during COVID-19 epidemic: a preliminary study on 63 patients

Acral cutaneous lesions in the Time of COVID-19

COVID-19) infection-induced chilblains: a case report with histopathological findings

A diverse range of gene products are effectors of the type I interferon antiviral response

Pathogenesis of Skin Injury of Systemic Lupus Erythematosus

Chilblain-like lesions on feet and hands during the COVID-19 Pandemic

Endothelial cell infection and endotheliitis in COVID-19

The patients in this manuscript have given written informed consent to the publication of their case details.The authors would like to thank all the hospital workers that have been battling in this pandemia, a special recognition of the Dermatology department of Hospital Principe de Asturias, fully involved in this fight.

This article is protected by copyright. All rights reserved