COVID-19 cutaneous manifestations in children and adolescents: a systematic review

Abstract

Objective: The aim of this study was to evaluate the coronavirus disease 2019 (COVID-19) cutaneous manifestations described in pediatric patients and discuss their relevance for early diagnosis. Data source: The study consisted of a systematic review of original articles indexed in PubMed and Embase databases, as well as gray literature articles found through Google Scholar. A search strategy, based on PICO (Patient, Intervention, Comparison, Outcome) Tool, with the terms “child,” “infant,” “childhood,” “adolescents,” “teenagers,” “COVID-19,” “SARS-CoV-2,” and “skin manifestations,” was performed to optimize the findings. The study did not restrict any article regarding language. Data synthesis: Out of the 310 articles that initially met the inclusion criteria, 35 were selected for review, totalizing 369 patients. The most common COVID-19 cutaneous manifestations in children and adolescents were Chilblain-like lesions, presented in 67.5% of the cases, followed by erythema multiforme-like (31.7%) and varicella-like lesions (0.8%). The Chilblain-like lesions appeared 7.6 days (95%CI 7.4–7.8) after the viral infection and lasted for 17.5 days (95%CI 16.5–18.5), erythema multiforme-like lesions appeared in 9.5 days (95%CI 9–10) and lasted for 10.3 days (95%CI 9.1–11.5), and varicella-like lesions appeared in 12.3 days (95%CI 4–20.6) and lasted for 7 days. Conclusions: Knowledge of the different skin manifestations in children and adolescents with COVID-19 is essential for an early diagnosis and, consequently, the possibility of promptly care adoption as well as to interrupt the new coronavirus transmission chains in the current pandemic context.

COVID-19 and Related Vaccinations in Children: Pathogenic Aspects of Oral Lesions

“…Macular lesions were also the predominant skin manifestations observed in SARS-CoV-2-positive children, followed by erosions [12,14,26,27]. In agreement, Shah et al [14] showed that most pediatric subjects had erythematous maculopapular skin eruptions, which are often the typical dermatological manifestation of viral infections, although their distribution was not typically cephalocaudal as in other viral exanthemas.…”

“…After duplicate elimination, those records not compliant with the eligibility criteria were excluded. Ten studies [3,[10][11][12][13][14][15][16][17][18] exclusively involved SARS-CoV-2-positive pediatric (<18 years old) cases with oral lesions and/or pediatric subjects with oral lesions after at least one administration of the COVID-19 EMA-authorized [8] and WHO Emergency Use Listing-approved vaccines [9].…”

“…Indeed, Pasquini Neto et al suggested that both oral and dermatologic manifestations may be initial signs of SARS-CoV-2 infection to watch for, as infected individuals may not show respiratory symptoms until 14 days after infection [26]. The recognition of these lesions is especially important in the pediatric population, which usually presents with mild to moderate forms of the disease [12].…”

Epidemiology, clinical profiles, and prognostic value of COVID‐19‐related cutaneous manifestations in African populations: a rapid narrative review

“…Another review including 34 studies around the world showed that acral lesions were the most common category identified (40.4% of all cases), followed by erythematous maculopapular rashes (21.3%), vesicular rashes (13.0%), urticarial rashes (10.9%), other ill‐defined rashes (4.3%), vascular rashes within the spectrum of livedo/purpura/necrosis (4%), erythema multiforme‐like eruptions (3.7%), and unspecified erythematous rashes (2.1%) 17 . Finally, a review of 369 children and adolescents with cutaneous manifestations found that the most common COVID‐19 cutaneous symptoms in this age group were chilblain‐like lesions (67.5%), followed by erythema multiforme‐like (31.7%) and to a varying degree varicella‐like lesions (0.8%) 18 . This appraisal of published literature showed that gathering dermatology‐related data about geographical differences in the morphology and prevalence of reported COVID‐19‐associated cutaneous manifestations is essential in each country and region, particularly on the African continent.…”

“…17 Finally, a review of 369 children and adolescents with cutaneous manifestations found that the most common COVID-19 cutaneous symptoms in this age group were chilblain-like lesions (67.5%), followed by erythema multiforme-like (31.7%) and to a varying degree varicella-like lesions (0.8%). 18 This appraisal of published literature showed that gathering dermatology-related data about geographical differences in the morphology and prevalence of reported COVID-19-associated cutaneous manifestations is essential in each country and region, particularly on the African continent.…”