{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T07:04:07Z","timestamp":1780470247890,"version":"3.54.1"},"reference-count":38,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2020,10,1]],"date-time":"2020-10-01T00:00:00Z","timestamp":1601510400000},"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":["J Cutan Pathol"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Prior studies have shown the presence of immunohistochemical staining for the SARS\u2010CoV\u20102 spike protein (SP) in endothelial cells and eccrine epithelium of acral perniosis classified as \u201cCOVID toes.\u201d Yet, other studies have been unable to detect SARS\u2010CoV\u20102 RNA in skin biopsies of \u201cCOVID toes\u201d by reverse\u2010transcriptase polymerase chain reaction testing.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>In order to address these apparently conflicting findings, we compared detection of SARS\u2010CoV\u20102 SP, through RNA in situ hybridization (ISH) vs immunohistochemistry (IHC), in skin biopsies of acral perniotic lesions presenting during the COVID\u201019 pandemic.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Three of six cases showed positive immunohistochemical labeling of endothelial cells, with one of three cases with sufficient depth also having labeling of eccrine glands, using an anti\u2010SP SARS\u2010CoV\u20102 antibody. These three cases positive with IHC were negative for SP by RNA ISH.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>While the gold standard for detection of SARS\u2010CoV\u20102 in tissue sections has yet to be determined, the detection of SARS\u2010CoV\u20102 SP alone without spike RNA suggests that cleaved SP may be present in cutaneous endothelial cells and eccrine epithelium, providing a potential pathogenetic mechanism of COVID\u201019 endotheliitis.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cup.13866","type":"journal-article","created":{"date-parts":[[2020,9,21]],"date-time":"2020-09-21T07:25:55Z","timestamp":1600673155000},"page":"47-52","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":40,"title":["Discordant <scp>anti\u2010SARS\u2010CoV<\/scp>\u20102 spike protein and <scp>RNA<\/scp> staining in cutaneous perniotic lesions suggests endothelial deposition of cleaved spike protein"],"prefix":"10.1111","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2270-2524","authenticated-orcid":false,"given":"Christine J.","family":"Ko","sequence":"first","affiliation":[{"name":"Department of Dermatology Yale Medical School  New Haven Connecticut USA"},{"name":"Department of Pathology Yale Medical School  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malini","family":"Harigopal","sequence":"additional","affiliation":[{"name":"Department of Pathology Yale Medical School  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7659-1105","authenticated-orcid":false,"given":"Jeff R.","family":"Gehlhausen","sequence":"additional","affiliation":[{"name":"Department of Dermatology Yale Medical School  New Haven Connecticut 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