Abstract
SummaryThe 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 manifestation of COVID‐19, chilblain‐like lesions. In Part 2, we review other manifestations, including erythema multiforme, urticaria and Kawasaki disease‐like inflammatory multisystemic syndrome, while in Part 3, 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.
Highlights
David Andina, MD a Anna Belloni-Fortina, MD b Christine Bodemer, MD c Ernesto Bonifazi, MD d Anca Chiriac, MD e Isabel Colmenero, MD f Andrea Diociaiuti, MD g May El-Hachem, MD g Laura Fertita MD h Dirk van Gysel, MD i Angela Hernández-Martín, MD a Thomas Hubiche, MD j Catalina Luca, MD e Luisa Martos-Cabrera, MD a Annabel Maruani, MD k Francesco Mazzotta, MD d A
This has been named paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 infection (PIMS-TS) in Europe (99) and multisystem inflammatory syndrome in children (MIS-C) in the United States (100)
In children with a diagnosis of Kawasaki disease (KD) during the COVID-19 pandemic RT-PCR was positive in only 20-38 % of Paediatric inflammatory multisystem syndrome (PIMS) cases (96,97), serologies were positive for IgG in 8090 % of them (96,97)
Summary
Erythema multiforme (EM) is an acute, self-limited hypersensitivity condition clinically characterized by a distinctive skin eruption with symmetrical erythematous lesions called iris or target lesions. The most common cause of EM is systemic infection (up to 90%), while drugassociated EM is reported in less than 10% of cases (54). An EM-like eruption has been observed associated with SARS-CoV-2 infection, both in adults and in children (10,56) (Figure 1). Four children (3 males and 1 female) with chilblain-like lesions had associated EM, with both true targets and targetoid lesions; one of these patients had a positive PCR for SARS-CoV-2, and skin biopsies carried out in 2 cases demonstrated endothelial positive immunohistochemistry stain to SARS-CoV-2 spike protein (20). Most cases reported of urticaria in COVID-19 were adults and in the authors’ experience, children with urticaria in the setting of COVID-19 appear mostly asymptomatic apart from the urticarial rash. Viral infections may cause non-immunological urticaria by mast cell activation via complement or vasculitis as COVID-19 virus binds angiotensin-converting enzyme 2 (ACE2) receptors onblood vessels. Urticaria might be associated with bradykinin in the kinin–kallikrein system in conjunction with ACE2 (64)
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