Related Articles Paraviral eruptions in the era of COVID 19 Do some skin manifestations point to a natural resistance to SARS CoV 2 Clin Dermatol 2020 Nov Dec 38 6 757 761 Authors Lipsker D Abstract 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 PMID 33341210 PubMed as supplied by publisher