Skin manifestations of COVID-19 in children: Part 3

Abstract

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.

Figure 1

Algorithm for diagnosis of COVID‐19 in children with a skin eruption. IHC, immunohistochemistry; LDH, lactate dehydrogenase; PIMS, paediatric inflammatory multisystem syndrome. *Fever > 38 °C, muscle pain, headaches, asthenia, cough, dyspnoea, nausea/vomiting/diarrhoea and anosmia/agueusia.

Figure 2

(a,b) Histopathology of chilblains in COVID‐19: (a) intense perivascular and perieccrine infiltrates; (b) oedema in the papillary dermis with both dermoepidermal and perivascular infiltrates; (c,d) prominent lymphocytic vasculitis with vessel wall damage in dermal vessels. Haematoxylin and eosin, original magnification (a) × 2; (b) × 10; (c) × 40; (d) × 100.