Acral peeling as the sole skin manifestation of COVID‐19 in children

Abstract

Skin manifestations in patients with COVID-19 have been extensively reported, mostly in adults. 1,2 Skin lesions in children with proven COVID-19 are much less frequent 3 and may show specific features not seen in adults, such as those associated with the multisystem inflammatory syndrome in children (MIS-C). 4 Once the microbiologic test for SARS-CoV-2 became widely available for all suspected cases in our institution (not only for admitted patients), we were able to diagnose the first case of acral pulpitis as an isolated sign of COVID-19 in children. 5 Due to the mild nature of this presentation, in December 2020, we recruited similar cases through an advertisement on the "Spanish Primary Care Pediatric Association" website.We present a series of six children infected with SARS-CoV-2 who presented with mild erythema and desquamation of the fingertips and/or toes as the only skin manifestation of COVID-19.Otherwise, all children had asymptomatic to mildly symptomatic disease. | C A S E REP ORTSData were collected anonymously. We recorded age, sex, personal history of previous diseases, previous treatments, epidemiologic background, skin symptoms, type and location of lesions, systemic symptoms, microbiological test performed, and therapies administered.Approval from the institutional Ethics Committee and Board was obtained. Informed consent was obtained for recording images in all patients.Six patients (four male and two female), age range 5-13 years, were included. Five had a positive microbiologic test for SARS-CoV-2 (three positive real-time polymerase chain reaction for SARS-CoV-2 and two positive rapid antigenic test). One patient had a negative

Epidemiology and clinical evolution of non-multisystem inflammatory syndrome (MIS-C) dermatological lesions in pediatric patients affected by SARS-CoV-2 infection: A systematic review of the literature

“…Moreover, acral peeling was reported in 7 patients by 2 studies [ 34 , 40 ]. Acral edema, erythematous papules and purpura, and nail Beau lines were rarely detected (Table 3 ).…”

Membranous desquamation of the hand in a 7‐year‐old boy with mild COVID‐19

“…Most cases of membranous desquamation in COVID‐19 have been reported in severely affected pediatric patients with multisystem inflammatory syndrome in children (MIS‐C); mild cases have rarely been reported. 1 Patients with Kawasaki disease typically present with desquamation of the skin around the nails, with erythema and edema. 2 Therefore, differentiation from other diseases presenting with the same signs is essential for the earliest treatment.…”

Top 10 acral skin manifestations associated with COVID‐19: A scoping review

“…Similar to other post infections with significant inflammatory response, alternation in regulation of expression of acral keratins can be considered as possible mechanism. 46 …”