key: cord-0863173-a22wbt91
authors: Elgarhy, Lamia Hamouda; Salem, Mohamed Labib
title: Could injured skin be a reservoir for SARS-COV2 virus spread?
date: 2020-06-09
journal: Clin Dermatol
DOI: 10.1016/j.clindermatol.2020.06.004
sha: 46d845a756c4d38c471fa5f10216b293f9d53d30
doc_id: 863173
cord_uid: a22wbt91

Abstract The current corona virus disease 2019 (COVID-19) outbreak which is caused by SARS-COV2 is still expanding. The authors tried to focus a spotlight on the injured skin as a reservoir of SARS-COV2 to decrease the infection rate.

Dear Editor, The current corona virus disease 2019 (COVID-19) outbreak, which is caused by SARS-COV2, is still rapidly spreading worldwide. The authors tried to focus a spotlight on the injured skin as a reservoir of SARS-COV2 to decrease the infection rate. Angiotensin-converting enzyme-2 (ACE2) receptor has been identified as the functional receptor of SARS-COV2. ACE2 receptor is expressed in many tissues, including alveolar epithelial type II cells in lungs.

When the spike protein of SARS-COV2 binds with ACE2 receptor on the lung cells, the lungs then serve as a reservoir for viral invasion and replication. The oral mucosa and intestine act also as alternative routes of viral transmission. (1) In the skin, immunoreactivity for ACE2 receptors was detected in basal cell layer of epidermis and hair follicles, eccrine glands, blood vessels and capillaries, sebaceous glands and its surrounding smooth muscle cells. As such, skin cells expressing ACE2 receptors can act as home cells and are prone to SARS-CoV2 invasion, facilitating cellular viral entry and replication. (1) COVID-19 isn`t only airborne through aerosols formed during medical procedures but also can be transmitted through saliva directly or indirectly even between patients without coughing or other respiratory symptoms. Virus can also be carried out in infectious respiratory secretions, small or large droplets and body fluids to contaminate oral, nasal, (2) and eye mucous membranes. (3) SARS-COV2 RNA was detected strong positive in samples of both eyes from two COVID-19 patients suggesting that this virus might be spread through conjunctival contact. (4) SARS-COV2 virus can be detected for up to 72 hours on some surfaces despite decreasing infectivity over time. (5) Of course this raised the attention towards Patients with defective skin barrier and receiving immunosuppressive therapy like psoriasis, atopic dermatitis, Autoimmune and non-autoimmune bullous diseases affecting skin and mucous membranes. We hypothesize that these diseases which affect skin and mucous membranes disrupting normal barrier and their treatments make these patients prone to SARS-COV-2 invasion. (6) Of course, further studies will be needed to isolate SARS-COV2 from active skin lesions of these diseases and find out the best way for protection of these patients. In addition, Skin protective measures as prolonged use of protective gloves leads to occlusion, epidermal maceration and erosions, frequent hand washing with soaps and disinfectants causes irritation, epidermal barrier injury, contact dermatitis and long-term water exposure induces skin irritation and epidermal barrier disruption. (7) In addition, on This may be one of the explanations of the rapidly increasing numbers of COVID-19 patients.

This prediction shouldn`t be ignored putting in consideration the required protective measures for patients and healthcare providers. It is highly recommended to apply a skin barrier cream under the face mask and after thoroughly washing and sanitizing the hands to guard against skin injury. For patients with skin injury, proper covering of active skin lesions with sterile dressings to guard against viral invasion. For suspected COVID 19 cases suffering from skin disease, we recommend upper respiratory swab as well as swabbing active skin lesion for SARS-COV2.

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