SARS-CoV-2 might transmit through the skin while the skin barrier function could be the mediator

Abstract

During the coronavirus disease 2019 (COVID-19) pandemic, it were reported that COVID-19 patients could have cutaneous symptoms, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was observed on the skin of COVID-19 patients, which indicated that the skin is one target of SARS-CoV-2. Meanwhile, reports about SARS-CoV-2 transmission through food cold-chain overpacks emerged. With the fact that SARS-CoV-2 could survive on the skin for more than 9 h, the skin could be implicated in SARS CoV-2 transmission. Angiotensin-converting enzyme 2 (ACE2), a critical membrane protein for SARS-CoV-2 that enters a host cell, was recognized to be associated with the risk of SARS-CoV-2 infection. Therefore, tissues that express ACE2 might have the potential to be infected by and transmit SARS-CoV-2. The skin is one such tissue that expresses ACE2. However, unlike the lung that expresses ACE2 on the upper-most epithelial layer, the skin is composed of different layers of cells that function as a barrier, and cells under the top epidermal layer express ACE2. Since the skin barrier is the first line of protection, the typical position of ACE2-expressing cells in the skin implies that the skin barrier function could be the mediator of SARS-CoV-2. In our study, we found that ACE2 could be expressed in the skin, and its expression level is increased in psoriasis, an inflammatory disease of the skin with barrier dysfunction. Additionally, by applying the SARS-CoV-2 pseudovirus on mouse models with or without deteriorated skin barrier, we found that the SARS-CoV-2 pseudovirus could infect the skin and lungs of mouse models, and when the skin barrier was impaired, more SARS-CoV-2-infected cells could be found. Thus, we hypothesized that a deteriorated condition of the skin barrier might increase the risk of SARS-CoV-2 infection through the skin.

Keywords: ACE2; ACE2, angiotensin-converting enzyme 2; AD, atopic dermatitis; Atopic dermatitis; COVID-19, coronavirus disease 2019; Psoriasis; SARS-CoV-2; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; Skin barrier.

Fig. 1

The hypothesis that deteriorated skin barrier might increase the risk of SARS-CoV-2 transmitting through skin.

Fig. 2

The expression of ACE2 in the lesion skin of patients with psoriasis and atopic dermatitis as well as the skin of normal control.

Fig. 3

The percentage of GFP cells in mouse models with induced psoriasis, atopic dermatitis and group control.