Paraviral cutaneous manifestations associated to SARS-CoV-2 Omicron variant

Abstract

Background

The spreading of the SARS-CoV-2 Omicron variant is probably due to its increased transmissibility and ability to escape from neutralising antibodies. Cutaneous manifestations have been reported after infection with the Omicron strain, consisting mainly of generalised urticarial eruption and prickly heat rash, also known as miliaria, that can persist for several days. Here the impact of Omicron SARS-CoV-2 on skin was investigated.

Methods

The case series of 10 patients with SARS-CoV-2 Omicron variant-related cutaneous manifestations were described; moreover, skin derived cells were challenged in vitro with SARS-CoV-2 Omicron variant.

Results

The main clinical cutaneous features observed were urticarial lesions lasting more than 24 h, mainly involving the trunk and sometimes extending to the extremities, and miliaria presenting with clusters of small sweat-filled vesicles, sometimes surrounded by slight erythema. HaCaT keratinocytes, BJ fibroblast cell lines and outer root sheath (ORS) keratinocytes were not susceptible to SARS-CoV-2 Omicron variant infection; they also did not present any evident cytopathic effect or modification of cells viability.

Conclusion

Our findings suggests that, despite the high number of nucleotide mutations in the spike protein of SARS-CoV-2 Omicron variant, responsible to the higher transmissibility of this virus, and the increased reports of cutaneous manifestation in COVID-19 affected patients, the virus is not able to directly infect and damage the keratinocytes and fibroblasts, thus suggesting an indirect virus-induced activation of the immune system as the major pathogenetic driver.

Keywords:

• SARS-CoV-2
• Omicron variant
• urticarial lesions
• miliaria
• COVID-19

Acknowledgment

The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results

Author contributions

Conceptualisation: A.V.M. and S.C.; Methodology, L.Z. and C.M.; Investigation, L.Z., C.M., P.M.T. and C.D.V.; Writing – Original Draft Preparation, L.Z. and C.M.; Writing – Review & Editing, F.F., A.V.M. and S.C.; Funding Acquisition, F.F., A.V.M and S.C.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

Open Access funding provided by the Qatar National Library. This work was supported by the Ministry of Health, Rome – Italy, through the contribution given to the Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste – Italy [RC 47/2020, and Starting Grant SG-2019- 12369421] and by the QUCG-CAS-22/23-499 Collaborative Grant from Qatar University.