Rare and common manifestations of COVID-19 in children

Abstract

Introduction: It has been almost 2 years since the first reports on cutaneous manifestations of COVID-19. Those reported in children are different and include macular, papular, lichenoid, vesicular, urticarial, and vascular morphologies, among others. The prognosis of isolated cutaneous involvement in COVID-19 in children is usually self-limiting but the extreme variety of clinical presentations complicates the clinical approach.

Methods: Numerous reviews have been systematically drafted and edited giving the clinicians a future direction for skin presentations during pandemics.

Results and discussion: Hereby we report the rare and common manifestations of COVID-19 in children and question the recurrence phenomena and age-related distribution of the eruptions.

Keywords: MIS‐C; Sars‐CoV‐2; chilblains; chilblain‐like; children.

Figure 1

(a−f) Moderately painful chilblain‐like lesions localized on the toes and fingers in male and female adolescents aged 12−17 years old

Figure 2

Chilblain‐like lesions associated to MIS‐C in a 13‐year‐old boy. Erythematous‐violaceous and infiltrated lesions located on the dorsal toes. The extremities were cold to the touch (a). Global and regional systolic function of the left ventricle with the strain method at first evaluation. Global Longitudinal Strain −14.8% (normal value > −19% to 20%) with hypokinesia of inferior anterolateral and inferior septal wall. After 3 months, global Longitudinal Strain −19.9% with mild residual hypokinesia of the inferior wall (b). MIS‐C, multisystem inflammatory syndrome

Figure 3

Maculopapular/papular‐purpuric eruptions involving the diaper area, arms and limbs in a 2‐year‐old child (a), and the limbs in 4‐ and 8‐year‐old girls (b,c), confirmed or suspected for SARS‐Cov‐2 infection

Figure 4

Diffuse oedematous and itchy urticarial lesions in a 12‐month‐old, SARS‐Cov‐2‐positive baby (a−c). Urticarial lesions in a 2‐year‐old boy (d)

Figure 5

CLLs (a) and EM‐like lesions (b,c) appearing in a 14‐year‐old, SARS‐Cov‐2‐positive boy. CLL, chilblain‐like lesion; EM, erythema multiforme

Figure 6

Diffuse, slightly elevated, purpuric papules on the trunk in an adolescent with PLEVA‐like exanthem (a). Widespread, red‐purple papules on the limbs in the same patient (b). PLEVA‐like, papular‐purpuric dermatitis of childhood

Figure 7

Non‐confluent, erythematous papules on the trunk and limbs on the 10th of a PLEVA‐like eruption (a). Purpuric and haemorrhagic aspect on dermoscopy (b). Histopathology in this patient shows superficial and deep perivascular dermatitis, extravasated red blood cells in the papillary dermis (red arrow) and dermal eccrine ducts surrounded by heavy lymphocytic infiltration (black arrow), Hematoxylin and eosin stain, original magnification ×40 (c). PLEVA‐like, papular‐purpuric dermatitis of childhood

Figure 8

Age distribution of SARS‐Cov‐2‐positive or suspected paediatric patients (0−18 years) observed in our centre during the first pandemic spread categorized by cutaneous manifestations. In the lower part of the figure, boxes correspond to the highest frequency rate of patients with the clinical characteristics mentioned. Lateral strings include all the sample span. CLLs, chilblain‐like lesions (COVID toes); EM‐like, erythema multiforme‐like; MIS‐C, multisystem inflammatory syndrome; PLEVA‐like, papular‐purpuric dermatitis of childhood