Cutaneous manifestations of COVID-19 in pediatric patients:  literature review

Ghadah Alhetheli

doi:10.18203/issn.2455-4529.IntJResDermatol20210537

Authors

Ghadah Alhetheli Department of Dermatology, Qassim University, Saudi Arabia http://orcid.org/0000-0002-3896-1873

DOI:

https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20210537

Keywords:

Coronavirus disease 2019, Children, Cutaneous manifestations, Histological findings, Pediatrics, COVID-19, Rash, Exanthem

Abstract

Cutaneous manifestations of coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are neglected during the early period of the spread of the pandemic. Moreover, the rational that children are immune against COVID-19 infections, allowed unnoticeable spread of the disease among children and adolescents. This review article aimed to shed light on the different cutaneous manifestations of COVID-19 among pediatric age group, its related pathogenesis and histopathological features. Review of literature published since the release of the details about the disease was conducted to examine various cutaneous manifestations related to the SARS-CoV-2 infection. Review of 35 articles concerned with COVID19-related skin manifestations in pediatrics showed that it was varied and included chilblain-like, maculopapular, urticarial, vesicular, targetoid, erythema multiforme-like and COVID-19 Kawasaki disease-like multisystem inflammatory syndrome in children (MIS-C), which is serious health condition. Despite of the previously documented higher production of interferon-α in children and adolescents, children are not immune against SARS-CoV-19 infection. Cutaneous manifestations in children are usually asymptomatic and are curable unless they are drug-related side effects during the course of treatment of COVID-19. This literature review and photo atlas provide a mini-analysis of COVID-19-related skin manifestations among pediatrics with reference to their tissue histopathological changes.

Metrics

Metrics Loading ...

References

Lai C, Ko W, Lee P, Jean S, Hsueh P: Extra-respiratory manifestations of COVID-19. Int J Antimicrob Agents. 2020;56(2):106024.

Aghdam M, Jafari N, Eftekhari K: Novel coronavirus in a 15-day-old neonate with clinical signs of sepsis, a case report. Infect Dis (Lond). 202;52(6):427-9.

Tang YW, Schmitz JE, Persing DH, Stratton CW: The laboratory diagnosis of COVID-19 infection: current issues and challenges. J Clin Microbiol. 2020.

Huang YC, Lee PI, Hsueh PR: Evolving reporting criteria of COVID-19 in Taiwan during the epidemic. J Microbiol Immunol Infect. 2020.

Leung T, Chan A, Chan E, Chan V, Chui C, Cowling B, et al. Short- and potential long-term adverse health outcomes of COVID-19: a rapid review. Emerg Microbes Infect. 2020;9(1):2190-9.

Recalcati S: Cutaneous manifestations in COVID-19: a first perspective. J Eur Acad Dermatol Venereol. 2020;34:e212-3

Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al: Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708–20.

Andina D, Belloni-Fortina A, Bodemer C, Bonifazi E, Chiriac A, Colmenero I, et al. ESPD Group for the Skin Manifestations of COVID-19. Skin manifestations of COVID-19 in children: Part 1. Clin Exp Dermatol. 2020.

Khalili M, Iranmanesh B, Mohammadi S, Aflatoonian M: Cutaneous and histopathological features of Coronavirus disease 2019 in pediatrics: A review article. Dermatol Ther. 2020.

Maestro I, Merino L, Del Tánago B, González A, Sopeña A, De Vicente J, Nieto J, Mariñas E, García J: Skin manifestations in patients hospitalized with confirmed COVID-19 disease: a cross-sectional study in a tertiary hospital. Int J Dermatol. 2020;24;10

Klimach A, Evans J, Stevens J, Creasey N: Rash as a presenting complaint in a child with COVID-19. Pediatr Dermatol. 2020;37(5):966-7.

Cordoro K, Reynolds S, Wattier R, McCalmont T: Clustered cases of acral perniosis: Clinical features, histopathology, and relationship to COVID-19. Pediatr Dermatol. 2020;37(3):419-23.

Torrelo A, Andina D, Santonja C, Noguera-Morel L, Bascuas-Arribas M, Gaitero-Tristán J, et al. Erythema multiforme-like lesions in children and COVID-19. Pediatr Dermatol. 2020;37(3):442-6.

Labé P, Ly A, Sin C, Nasser M, Chapelon-Fromont E, Ben Saïd P, Mahé E: Erythema multiforme and Kawasaki disease associated with COVID-19 infection in children. J Eur Acad Dermatol Venereol. 2020;34(10):e539-41.

Yozgat C, Uzuner S, Duramaz B, Yozgat Y, Erenberk U, Iscan A, Ture O: Dermatological Manifestation of Pediatrics Multisystem Inflammatory Syndrome Associated with COVID-19 in a 3-Year-Old Girl. Dermatol Ther. 202;33(4):e13770.

Corneau A, Boussier J, Smith N, Péré H, Charbit B, Bondet V, et al. Impaired type I interferon activity and exacerbated inflammatory responses in severe Covid-19 patients. Science. 2020;369:718–24.

Colonna C, Monzani NA, Rocchi A, Gianotti R, Boggio F, Gelmetti C: Chilblain-like lesions in children following suspected COVID-19 infection. Pediatr Dermatol 2020;37:437–40

Li G, Ju J, Weyand CM, Goronzy JJ: Age-associated failure to adjust type I IFN receptor signaling thresholds after T cell activation. J Immunol 2015;195:865–74.

Zhang Y, Xiao M, Xia P, Cao W, Jiang W, Chen H, et a. Coagulopathy and antiphospholipid antibodies in patients with Covid-19. N Engl J Med 2020;2020:e38.

Perrotta F, Matera MG, Cazzola M, Bianco A: Severe respiratory SARS-CoV2 infection: does ACE2 receptor matter? Respir Med 2020;168: 105996.

He L, Mae MA, Sun Y, Pietilä R, Nahar K, Liébanas E, Fagerlund M, Oldner A, Liu J: Pericyte-specific vascular expression of SARS-CoV-2 receptor ACE2 – implications for microvascular inflammation and hypercoagulopathy in COVID-19 patients. Med Hypotheses 2020;144:110015.

Colmenero I, Santonja C, Alonso-Riano M, Andina D, Rodríguez Peralto JL, Requena L, Torrelo A: SARSCOV-2 endothelial infection causes COVID-19 chilblains: histopathological, immunohistochemical and ultrastructural study of 7 paediatric patients. Br J Dermatol 2020;183:729–37.

Kaushik S, Aydin SI, Derespina KR, Bansal PB, Kowalsky S, Trachtman R, Gillen JK, Perez MM, Soshnick SH, Conway EE Jr, Bercow A, Seiden HS, Pass RH, Ushay HM, Ofori-Amanfo G, Medar SS: Multisystem inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2 infection: a multiinstitutional study from New York City. J Pediatr. 2020;224:24–9.

Fernandez-Nieto D, Ortega-Quijano D, Jimenez-Cauhe J, Burgos-Blasco P, de Perosanz-Lobo D, Suarez-Valle A, et al. Clinical and histological characterization of vesicular COVID-19 rashes: a prospective study in a tertiary care hospital. Clin Exp Dermatol. 2020;45(7):872-5.

Criado PR, Abdalla BMZ, de Assis IC, van Blarcum de Graaff Mello C, Caputo GC, Vieira IC: Are the cutaneous manifestations during or due to SARSCoV-2 infection/COVID-19 frequent or not? Revision of possible pathophysiologic mechanisms. Inflamm Res. 2020;69:745–56.

Nakra NA, Blumberg DA, Herrera-Guerra A, Lakshminrusimha S: Multi-system inflammatory syndrome in children (MIS-C) following SARS-CoV-2 infection: review of clinical presentation, hypothetical pathogenesis, and proposed management. Children (Basel). 2020;7:69.

McCrindle BW, Manlhiot C. SARS-CoV-2-related inflammatory multisystem syndrome in children: different or shared etiology and pathophysiology as Kawasaki disease. J Am Med Assoc. 2020;324:246–8.

Licciardi F, Pruccoli G, Denina M, Parodi E, Taglietto M, Rosati S. SARS-CoV-2-induced Kawasaki-like hyperinflammatory syndrome: a novel COVID phenotype in children. Pediatrics. 2020;146.

Rowley AH: Understanding SARS-CoV-2-related multisystem inflammatory syndrome in children. Nat Rev Immunol. 2020;20:453–4.

Jin Y, Yang H, Ji W, Wu W, Chen S, Zhang W, Duan G: Virology, Epidemiology, Pathogenesis, and Control of COVID-19. Viruses. 2020;12(4):372.

El Hachem M, Diociaiuti A, Concato C, Carsetti R, Carnevale C, Ciofi Degli Atti M. A clinical, histopathological and laboratory study of 19 consecutive Italian paediatric patients with chilblain-like lesions: lights and shadows on the relationship with COVID-19 infection. J Eur Acad Dermatol Venereol. 2020.

Zengarini C, Orioni G, Cascavilla A, Solera C, Fulgaro C, Misciali C. Histological pattern in COVID-19-induced viral rash. J Eur Acad Dermatol Venereol. 2020;34(9):e453-4.

Marzano A, Genovese G, Fabbrocini G, Pigatto P, Monfrecola G, Piraccini B, et al. Varicella-like exanthem as a specific COVID-19-associated skin manifestation: Multicenter case series of 22 patients. J Am Acad Dermatol. 2020;83(1):280-5.

Gianotti R, Recalcati S, Fantini F, Riva C, Milani M, Dainese E, et al. Histopathological Study of a Broad Spectrum of Skin Dermatoses in Patients Affected or Highly Suspected of Infection by COVID-19 in the Northern Part of Italy: Analysis of the Many Faces of the Viral-Induced Skin Diseases in Previous and New Reported Cases. Am J Dermatopathol. 2020;42(8):564-70.