Cutaneous coronavirus disease 2019 in children: a clinical primer for diagnosis and treatment

Abstract

Purpose of review This review examines the global literature regarding rashes encountered in children and adults infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and aims to provide practicing pediatricians with an understanding of the relationship between instances of rashes and coronavirus disease 2019 (COVID-19) in children in order to effectively evaluate and treat patients. Recent findings The true incidence of cutaneous reactions in children infected with SARS-CoV-2 is not known. Children's immune systems differ from those of adults and rashes as a manifestation of immune responses, in turn, differ in morphology and distribution. Rarely, children develop a severe multisystem inflammatory syndrome that has overlapping clinical features with Kawasaki disease. In addition, vaccinations produce rashes similar to natural infections. The rashes associated with COVID-19 vaccination are mild and transient, and should not preclude vaccination. Lastly, children who chronically wear masks are more likely to experience flaring of acne around the nose and mouth (’maskne’) and facial conditions such as seborrheic dermatitis. Summary There are ongoing worldwide registries, clinical and basic science studies to better understand the burden of skin disease and pathophysiology of rashes seen in patients infected with COVID-19. Robust vaccination programs should be encouraged as a way to contain viral spread among children and the greater population.

Maskne: The Epidemic within the Pandemic: From Diagnosis to Therapy

“…Additional studies confirmed that rosacea, irritant contact dermatitis, and acne [8,9] worsened after mask use, even among children [10]. It is also acknowledged that acne could contribute to mask-induced itch [11].…”

Clinical Factors Associated with COVID-19 Severity in Chronic Hospitalized Infants and Toddlers: Data from a Center in the West Part of Romania

“…This could be one of the factors influencing our group's relatively high SARS-CoV-2 infection rate. However, additional studies confirmed that rosacea, irritant contact dermatitis, and acne [28,29] worsened after mask use, even among children [30], consequently reducing the use of face masks. In very young children, data are missing because the Romanian Ministry of Health, in line with WHO recommendations, stated that face masks in children aged 5 years and under are not mandatory [31].…”

A case of retiform purpura secondary to sepsis, successfully managed with a combination of antibiotics and steroids

“…Though this child had features of bacterial infections, the exact organism was not isolated. Covid-19 has been identified as a recognized cause of RP in children 3 . However, in our case, Covid -19 antibodies were negative.…”

“…Medium vessel vasculitis such as PAN and Kawasaki disease are important aetiologies of RP 4 . In addition, PAN could be associated with streptococcal infections 3 . However, in our child, features suggestive of vasculitis such as haematuria, thrombocytosis and eosinophilia were not found.…”