Dermatological Manifestations of COVID-19 in Children

Abstract

Context The clinical picture of pediatric severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infection differs from adults as do the cutaneous manifestations. In this review, we summarize the varied morphological manifestations of SARS-CoV-2 infection in the pediatric population. Evidence acquisition A comprehensive literature search was conducted (23 September, 2021) across multiple databases (PubMed, EMBASE, MEDLINE and Cochrane) with the relevant keywords. An additional filter of age group between 0–18 years was kept in each of the searches. Results Chilblains constitute the most common cutaneous manifestation of pediatric coronavirus disease (COVID-19). Other commonly reported manifestations include maculopapular rash, urticaria, erythema multiforme, and papulovesicular eruptions. Majority of children with these manifestations are asymptomatic, highlighting the need to clinically suspect and appropriately manage such patients. A subset of pediatric patients develop severe multisystem involvement termed as multi-system inflammatory syndrome in children (MIS-C) that has varied mucocutaneous manifestations. Conclusion A wide variety of dermatological manifestation of SARS-CoV-2 infection is reported, and both the pediatrician and dermatologist need to be aware of the same to suspect and diagnose COVID-19 infection in children. Electronic Supplementary Material Supplementary material is available in the online version of this article at 10.1007/s13312-022-2521-6.

Post‐Covid cutaneous small‐vessel vasculitis with features of Koebnerization

“…One of them is that immune complexes aggregate in vessels due to local inflammation in response to scratching or local trauma, leading to recurring lesions. 5 Besides, it has been hypothesized that elevated levels of tryptase following a trauma may be responsible.…”

COVID‐associated non‐vasculitic thrombotic retiform purpura of the face and extremities: A case report

“…The robust production of IFN‐I in the pediatric population may explain the lower rates of respiratory and systemic symptoms. This is significant since these COVID‐19 perniosis‐like lesions are like those described in patients with interferonopathies where there is a defective regulation that causes excess production of interferons 14–17 . The mechanisms are comparable of the interferon‐mediated, pre‐COVID‐19 era pernio‐like rashes; specifically, there is an activation of the angiotensin II pathway–mediated proinflammatory and prothrombotic activity as well as increased vasospasm associated with increased release of IFN‐I 17–19 .…”

Mucocutaneous manifestations of COVID-19-related multisystem inflammatory syndrome in adults: an update

“…Over the past 2 years, healthcare providers across the globe have described a gamut of mucocutaneous manifestations that precede, appear simultaneously with or follow typical COVID‐19 symptoms. 1 In June 2020, multisystem inflammatory syndrome in adults (MIS‐A) received attention when the US Centers for Disease Control and Prevention (CDC) began receiving initial reports of patients presenting with delayed and multisystem involvement of the disease, with a clinical course resembling MIS in children (MIS‐C). Initially, two terminologies were used: ‘multisystem inflammatory syndrome in adults’ (MIS‐A) and adult‐onset ‘paediatric multisystem inflammatory syndrome’ (PIMS).…”

“…In March 2020, WHO declared severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2)‐induced novel coronavirus 2019 (COVID‐19) infection a pandemic. Over the past 2 years, healthcare providers across the globe have described a gamut of mucocutaneous manifestations that precede, appear simultaneously with or follow typical COVID‐19 symptoms 1 . In June 2020, multisystem inflammatory syndrome in adults (MIS‐A) received attention when the US Centers for Disease Control and Prevention (CDC) began receiving initial reports of patients presenting with delayed and multisystem involvement of the disease, with a clinical course resembling MIS in children (MIS‐C).…”