Extensive expression of SARS‐CoV‐2 spike protein from the eccrine secretory gland to acrosyringium in the maculopapular eruption of a COVID‐19 patient

• Published in: Journal of dermatology 2022-01, Vol.49 (1), p.e11-e12
• Main Authors: Nishimori, Nobuyuki, Niwa, Yusuke, Kazama, Akio, Yamamoto, Michiko, Fujita, Hideki
• Format: Article
• Language: English
• Subjects: COVID-19; Eccrine Glands; Humans; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Spike Glycoprotein, Coronavirus; Spike protein
• ISSN: 0385-2407; 1346-8138
• DOI: 10.1111/1346-8138.16187

See PDF.] Chilblain-like eruption is well-known COVID-19-related skin condition.2 Santonja et al. found SARS-CoV-2 spike protein expression in blood vessel endothelium and sweat gland epithelium in COVID-19 chilblain-like skin lesions.3 On the other hand, while maculopapular lesions are also common COVID-19 skin manifestation,1 expression of SARS-CoV-2 spike protein in the lesional skin is totally unknown. [...]SARS-CoV-2 spike protein was identified in dermal vascular endothelial cells as well as eccrine secretory glands, dermal ducts, and acrosyringia. [...]this is the first report demonstrating the presence of SARS-CoV-2 spike protein in maculopapular-type rash. Using COVID-19 patients’ skin samples, it is reported that SARS-CoV-2 readily infects sweat gland Krt7+ secretory luminal cells co-expressing angiotensin-converting enzyme 2 and transmembrane protease serine 2.4 SARS-CoV-2 infection in eccrine glands may result in the excretion of viruses and viral proteins into sweat.4 However, SARS-CoV-2 was not detected in the perspiration of COVID-19 patients, albeit the examined patients did not have skin rash.5 Extensive SARS-CoV-2 viral protein expression in our case suggests the possibility that the viruses may be egested to the skin surface via sweating.