Skin manifestations of COVID‐19 in children: Part 3

Abstract

Summary The current COVID‐19 pandemic is caused by the SARS‐CoV‐2 coronavirus. The initial recognized symptoms were respiratory, sometimes culminating in severe respiratory distress requiring ventilation, and causing death in a percentage of those infected. As time has passed, other symptoms have been recognized. The initial reports of cutaneous manifestations were from Italian dermatologists, probably because Italy was the first European country to be heavily affected by the pandemic. The overall clinical presentation, course and outcome of SARS‐CoV‐2 infection in children differ from those in adults as do the cutaneous manifestations of childhood. In this review, we summarize the current knowledge on the cutaneous manifestations of COVID‐19 in children after thorough and critical review of articles published in the literature and from the personal experience of a large panel of paediatric dermatologists in Europe. In Part 1, we discuss one of the first and most widespread cutaneous manifestations of COVID‐19, chilblain‐like lesions, and in Part 2 we expanded to other manifestations, including erythema multiforme, urticaria and Kawasaki disease‐like inflammatory multisystemic syndrome. In this part of the review, we discuss the histological findings of COVID‐19 manifestations, and the testing and management of infected children for both COVID‐19 and any other pre‐existing conditions.

Chilblains in a child with confirmed SARS‐CoV‐2 infection: a red flag for late‐onset skin manifestation in previously infected individuals

“…There has been a wide controversy about the causal relation between COVID-19 and CLL as many patients do not show other symptoms and RT-PCR tests from skin specimens and even serological studies are often negative. 2,[5][6][7][8] Attending to the results of our study, IgG antibodies against SARS-CoV-2 appear to be indeed a risk factor for CLL that overall occur in asymptomatic or mildly symptomatic patients, as none of the patients required hospitalization. It should be noted that more than half of the cases were seronegative.…”

“…No histological findings of leucocytoclastic vasculitis were observed. 7,8 The negative result of RT-PCR assay on the skin lesion, combined with the positivity of serology tests (IgG) performed during the chilblain relapse, supports the hypothesis that the acral skin injury might not be the result of endothelial infection, but of immune-mediated response triggered by SARS-CoV-2. A robust IFN-I response therefore explains the contemporary low viraemia (often with negative PCR testing) and the localized endothelial damage in the acral site with mild or no associated symptoms.…”

Inflammatory Skin Lesions in Three SARS-CoV-2 Swab-Negative Adolescents: A Possible COVID-19 Sneaky Manifestation?

“…Various reports [ 1 , 2 , 3 , 4 , 5 , 6 ] have offered clinical documentation of cutaneous lesions in adults, such as Erythema Pernio, Erythema Multiforme, Chilblains, Urticated Erythema, Morbilliform, Varicelliform, Chickenpox-like exanthem, etc. In the pediatric population, the incidence of skin manifestations reported by various authors is low: 0.25% [ 7 , 8 ]. Biopsies from skin lesions in children with confirmed or suspected COVID-19 have rarely been described in the literature [ 8 ].…”

Urticaria multiforme in a child with SARS-CoV-2 infection

“…[1][2][3] Of note, pediatric patients with skin lesions related to SARS-CoV-2 may be otherwise asymptomatic or experience only mild respiratory and gastrointestinal symptoms. [5][6][7] Skin involvement might be an element of multisystem inflammatory syndrome in children, which should be taken into consideration, especially in the setting of fever. 6 This presentation shares common features with mucocutaneous lesions found in Kawasaki disease, which is characterized by polymorphic, nonvesicular eruptions, erythema and edema of hands and feet along with nonsuppurative conjunctivitis and strawberry tongue.…”