{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T14:44:35Z","timestamp":1776437075059,"version":"3.51.2"},"reference-count":29,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2021,7,2]],"date-time":"2021-07-02T00:00:00Z","timestamp":1625184000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J Dermatology"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Several skin manifestations have been reported since the start of the COVID\u201019 pandemic: chilblains\u2010like, livedoid lesions, urticaria\u2010like, pseudo\u2010Kawasaki disease, and others. Histopathologic images of these lesions most often show aspects of endothelitis, images similar to autoimmune vasculitis. Cutaneous lesions are often negative at RT\u2010PCR for SARS\u2010CoV\u20102 virus.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method and Results<\/jats:title><jats:p>We reviewed recent articles on the mechanisms of COVID\u201019 and we synthesized main pathways of inflammatory cascade. After the penetration into the cells of the respiratory epithelium, SARS\u2010CoV\u20102 virus initiates a \u201ccytokine storm\u201d well described in previous publications: the expression of interferon type I (IFN\u2010I) is one of the key elements of the antiviral response in COVID\u201019 patients, IFN\u2010I expression seems to play an important role in the induction of interleukin 6 (IL\u20106), chemotactic factors such as Granulocyte\u2010Macrophage Colony\u2010Stimulating Factor (GM\u2010CSF) and the consequent activation of monocyte\u2010macrophage system followed by the expression of TNF\u2010alpha, and finally by the induction of coagulation factors by both extrinsic and intrinsic pathways.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The simplified synthesis of the main pathophysiological mechanisms of COVID\u201019 could help us to understand at least partially the importance of macrophage activation and its vascular involvement in many skin lesions that remain often negative at <jats:italic>in\u00a0situ<\/jats:italic> tests for SARS\u2010CoV\u20102.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ijd.15749","type":"journal-article","created":{"date-parts":[[2021,7,2]],"date-time":"2021-07-02T13:50:36Z","timestamp":1625233836000},"page":"3-6","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["COVID\u201019 skin lesions are rarely positive at RT\u2010PCR test: the macrophage activation with vascular impact and SARS\u2010CoV\u20102\u2010induced cytokine storm"],"prefix":"10.1111","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2569-8527","authenticated-orcid":false,"given":"Marius\u2010Anton","family":"Ionescu","sequence":"first","affiliation":[{"name":"Dermatology Department University Hospital \u201cSaint Louis\u201d Paris 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