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

Abstract

COVID-19 can present with a range of skin manifestations, some of which specific of the pediatric age. The aim of this systematic literature review was to determine the type, prevalence, time of onset, and evolution of cutaneous manifestations associated with COVID-19 in newborns, children, and adolescents, after excluding multisystem inflammatory syndrome in children (MIS-C). PubMed, Tripdatabase, ClinicalTrials, and Cochrane Library databases were searched using an ad hoc string for case reports/series and observational studies, published between December 2019 and February 2022. Study quality was assessed using the STROBE and CARE tools. Seventy-three (49 case reports/series and 24 studies) out of 26,545 identified articles were included in the analysis. Dermatological lesions were highly heterogeneous for clinical presentation, time of onset, and association with other COVID-19 manifestations. Overall, they mainly affected the acral portions, and typically presented a favorable outcome. Pseudo-chilblains were the most common. Conclusions : Mucocutaneous manifestations could be the only/predominant and early manifestation of COVID-19 that could precede other more severe manifestations by days or weeks. Therefore, physicians of all disciplines should be familiar with them. What is Known: • A variety of cutaneous manifestations have been reported in association with COVID-19. • Urticaria, maculopapular, or vesicular rashes can occur at any age, while chilblains and erythema multiforme are more common in children and young patients. What is New: • Skin lesions related to SARS-CoV-2 infection often show a peculiar acral distribution. • Mucocutaneous lesions of various type may be the only/predominant manifestation of COVID-19; they could present in paucisymptomatic and severely ill patients and occur at different stages of the disease. Supplementary Information The online version contains supplementary material available at 10.1007/s00431-022-04585-7.

COVID-19 and Related Vaccinations in Children: Pathogenic Aspects of Oral Lesions

“…Macular lesions were also the predominant skin manifestations observed in SARS-CoV-2-positive children, followed by erosions [12,14,26,27]. In agreement, Shah et al [14] showed that most pediatric subjects had erythematous maculopapular skin eruptions, which are often the typical dermatological manifestation of viral infections, although their distribution was not typically cephalocaudal as in other viral exanthemas.…”

“…Most oral lesions reported in pediatric SARS-CoV-2-positive subjects were part of the multisystem syndromic spectrum; hence, they were not described in detail or not described by oral medicine physicians with heterogeneous denominations. Indeed, oral lesions are one of the earliest symptoms of MIS-C and KD [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27].…”

“…Despite the heterogeneous terminology, ulcerative/erosive phenotype lesions and macules/petechiae, predominantly in an erythematous form, appear to be the most common oral lesions in pediatric SARS-CoV-2-positive patients [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27].…”

“…In addition, while maculopapular viral exanthemas generally heal with exfoliation, the lesions described in SARS-CoV-2-positive children typically progressed to erosions, vesiculation, and crusting [14]. Consequently, acral distribution and distal extremities with the appearance of exanthema are more likely attributable to Parvovirus B19 infections, causing the so-called "glove and sock syndrome" and "acropetecic syndrome" [27].…”

“…Nonetheless, the distribution of maculopapular lesions on the distal extremities and the possible association with oral lesions are commonly observed in EM, an immunemediated reaction caused by infections or drugs [27], which could be, in turn, considered indicative of SARS-CoV-2 infection.…”