The interactions of viruses with the skin immune system are not well understood. The interface of poxviruses with skin is especially intriguing, given that (i) skin infection and disfigurement are prominent features of smallpox disease; (ii) successful smallpox immunization is achieved by intentional skin infection with vaccinia virus; and (iii) eczema vaccinatum is a major severe complication of vaccination in people with atopic dermatitis (AD), a condition associated with defects in skin barrier function and antiviral innate immunity (25,26,69). Concerns about smallpox as a bioterrorism threat against an unvaccinated population, the persistence of monkeypox in Africa and episodes of its extracontinental spread, and the imperative to improve smallpox vaccination strategies all focus attention on poxvirus-host dynamics, particularly with skin. A recent case of life-threatening eczema vaccinatum in a child with AD who became infected by mere household contact with a smallpox vaccinee and then passed the infection on to a third party (68) highlights just how delicate the balance is between poxvirus virulence and skin immunity.Keratinocytes comprise the predominant cell type in the epidermis. Liu et al. (43) reported that vaccinia virus had limited replicative capacity in human keratinocytes and that infection induced keratinocytes to produce the Th2 cytokines transforming growth factor , interleukin-10 (IL-10), and IL-13, which suggested that vaccinia virus might downregulate skin immune responses. Human keratinocytes express Toll-like receptors (TLRs) that initiate innate immune signaling by binding to ligands referred to as pathogen-associated molecular patterns (30,40,47,49). Human keratinocytes produce a repertoire of cytokines, chemokines, and antimicrobial peptides in response to TLR stimulation (6,40,66). Such cytokines and chemokines augment innate and acquired immunity mediated by dendritic cells, neutrophils, macrophages, NK cells, and T cells, which reside in the skin or are recruited to the skin in the setting of infection or inflammation (39).The type I interferons (IFN-␣ and IFN-) are key mediators of antiviral innate immunity (65). Double-stranded RNA (dsRNA) introduced during virus infection is a potent inducer of the type I IFN response. dsRNA can trigger distinct signaling pathways by engaging either (i) the endosomal membrane-bound receptor TLR3 (42), (ii) the soluble cytoplasmic receptors 29,31,73), or (iii) the dsRNA-dependent protein kinase PKR (16). Signaling through TLR3 leads to activation of the transcription factors IFN regulatory factor 3 (IRF3) and NF-B via the adaptor molecule TRIF. As a consequence, IRF3 is phosphorylated and then moves to the nucleus to activate IFN- expression (59). In contrast, cytoplasmic dsRNA produced during replication of RNA viruses binds to RIG-I or MDA5 and triggers activation of IRF3 and NF-B through the mitochondrial antiviral signaling protein, MAVS