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.
Subject(s)
COVID-19 , Miliaria , Humans , SARS-CoV-2 , COVID-19/complications , SkinABSTRACT
Background: Coronavirus disease-2019 (COVID-19) has been shown to involve multiple-organ systems during disease process. Dermatologists have also reported various findings in patients of COVID-19 and have pointed out few cutaneous manifestations that are novel and are probably related to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, currently very limited data are available regarding various aspects of cutaneous involvement. Aims: This study aimed to investigate various aspects of cutaneous involvement in COVID-19. Methods: Institutional ethics committee approval was secured before conducting a study. Patients with at least one positive nasopharyngeal swab result for SARS-CoV-2 carried out by reverse transcription polymerase chain reaction (RT-PCR) were enrolled. After informed consent subjects were interviewed and monitored for appearance of any cutaneous signs and symptoms. Those with relevant findings were evaluated for characteristics of cutaneous findings. Data of all patients were collected and analyzed. Results: A total of 303 patients were enrolled for the study. Approximately 1.98% of patients developed cutaneous manifestations. Four types of skin lesions were observed in study subjects: urticarial lesions, maculopapular rash, acro-ischemia, and glossitis. Limitations: Relatively less number of patients, collection of data from single center, and absence of histopathological confirmation were limitations of the study. Conclusion: COVID-19 disease process has a cutaneous component;however, incidence of cutaneous findings remains low. Urticaria was the most common type of cutaneous finding, whereas acro-ischemia was the most characteristic one.
ABSTRACT
Coronavirus disease 2019 (COVID-19) is a multiple organ disease caused by SARS-CoV-2 virus infection. Among the organs and tissues affected by the disease, the skin has received less attention. Skin is the largest tissue in the body and is responsible for temperature maintenance, protection against external dangers and dehydration, and other roles. Although the skin manifestations of COVID-19 are common, the lack of standardization in the description of its signs makes it difficult to group them together. Considering the literature available so far, the skin manifestations can be divided into 4 patterns: exanthem, urticarial lesions, vascular and acro-papular eruptions. The localization, age, onset, symptoms and severity vary among them. The treatment, when necessary, is usually focused on the inflammatory response control. The pathophysiological mechanisms seem to involve the apoptosis of keratinocytes as well as endothelial cell dysfunction, favouring the establishment of skin inflammation. The better characterization of the skin manifestations is essential to understand the possible effects of COVID-19 on skin as well as for the development of appropriate treatments.