Epidemiology and clinical evolution of non-multisystem inflammatory syndrome (MIS-C) dermatological lesions in pediatric patients affected by SARS-CoV-2 infection: A systematic review of the literature

Arianna Dondi; Giacomo Sperti; Davide Gori; Federica Guaraldi; Marco Montalti; Lorenza Parini; Bianca Maria Piraccini; Marcello Lanari; Iria Neri

doi:10.1007/s00431-022-04585-7

Epidemiology and clinical evolution of non-multisystem inflammatory syndrome (MIS-C) dermatological lesions in pediatric patients affected by SARS-CoV-2 infection: A systematic review of the literature

Eur J Pediatr. 2022 Oct;181(10):3577-3593. doi: 10.1007/s00431-022-04585-7. Epub 2022 Aug 10.

Authors

Affiliations

¹ Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy.
² School of Pediatrics, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
³ Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
⁴ IRCCS Istituto Delle Scienze Neurologiche Di Bologna, 40139, Bologna, Italy. federica.guaraldi@ausl.bologna.it.
⁵ School of Hygiene and Preventive Medicine, Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, Public Health and Medical Statistics, University of Bologna, Bologna, Italy.
⁶ Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy.

^# Contributed equally.

Abstract

COVID-19 can present with a range of skin manifestations, some of which specific of the pediatric age. The aim of this systematic literature review was to determine the type, prevalence, time of onset, and evolution of cutaneous manifestations associated with COVID-19 in newborns, children, and adolescents, after excluding multisystem inflammatory syndrome in children (MIS-C). PubMed, Tripdatabase, ClinicalTrials, and Cochrane Library databases were searched using an ad hoc string for case reports/series and observational studies, published between December 2019 and February 2022. Study quality was assessed using the STROBE and CARE tools. Seventy-three (49 case reports/series and 24 studies) out of 26,545 identified articles were included in the analysis. Dermatological lesions were highly heterogeneous for clinical presentation, time of onset, and association with other COVID-19 manifestations. Overall, they mainly affected the acral portions, and typically presented a favorable outcome. Pseudo-chilblains were the most common.

Conclusions: Mucocutaneous manifestations could be the only/predominant and early manifestation of COVID-19 that could precede other more severe manifestations by days or weeks. Therefore, physicians of all disciplines should be familiar with them.

What is known: • A variety of cutaneous manifestations have been reported in association with COVID-19. • Urticaria, maculopapular, or vesicular rashes can occur at any age, while chilblains and erythema multiforme are more common in children and young patients.

What is new: • Skin lesions related to SARS-CoV-2 infection often show a peculiar acral distribution. • Mucocutaneous lesions of various type may be the only/predominant manifestation of COVID-19; they could present in paucisymptomatic and severely ill patients and occur at different stages of the disease.

Keywords: COVID-19; Cutaneous acral lesions; Erythema multiforme; Pediatric dermatology; Pseudo-chilblains.

Publication types

Review
Systematic Review

MeSH terms

Adolescent
COVID-19* / complications
COVID-19* / epidemiology
Chilblains*
Child
Humans
Infant, Newborn
SARS-CoV-2
Skin Diseases* / epidemiology
Skin Diseases* / etiology
Systemic Inflammatory Response Syndrome

Supplementary concepts

pediatric multisystem inflammatory disease, COVID-19 related