Highlights from

AAD 2021

American Academy of Dermatology Virtual Meeting Experience 2021

Virtual 23-25 April 2021

Skin manifestations of COVID-19 in children

Summary: Even when severe signs of COVID-19 in children may be absent, cutaneous signs are not uncommon and may be the only clue toward paediatric COVID-19. Multisystem inflammatory syndrome in children (MIS-C) and pernio-like lesions (PLLs) are known consequences after infection.

COVID-19 affects people of all ages. Infections can occur as early as in the neonatal period, but severe disease in children is uncommon. Why is COVID-19 so mild in the paediatric population? Prof Elena Hawryluk (Harvard Medical School, US) explained that children have fewer predisposing factors such as diabetes and hypertension.1 They have healthy endothelium and a strong antiviral innate immunity. Additionally, they have fewer angiotensin-converting enzyme receptors in nasal and lung epithelium which makes it harder for the virus to enter cells.

MIS-C is a serious, sometimes life-threatening response to SARS-CoV-2 infection in children, leading to organ dysfunction, shock, and sometimes the need for intensive care and circulatory support. This syndrome can affect many organ systems. MIS-C is considered a post-viral consequence of COVID-19 in which symptoms occur at a median of 25 days after SARS-CoV-2 infection. Higher incidence is found in minority children and there is a slight male predominance. Skin and/or mucous membrane changes may be present in over half of children affected by MIS-C. Although most require intensive care, patients with MIS-C carry a good prognosis, with mortality estimated at 2%.

PLLs likely represent an inflammatory response to COVID-19 resulting in purpuric and erythematous acral cutaneous surfaces. Children and young adults have a higher risk of manifesting with PLLs than older adults, likely related to immune mechanisms, as the immune system of younger individuals produces a high amount of interferon. PLLs are typically self-limiting with an excellent prognosis.

There are several case reports and series of various cutaneous eruptions in COVID-19-positive children. Drawing associations between non-specific eruptions and COVID-19 without biopsy or large cohort support can be difficult. Children with COVID-19 and skin manifestations carry an overall better prognosis than those without.

  1. Hawryluk E. COVID-19 in paediatric dermatology. Session S028: COVID-19 symposium. AAD VMX 2021, 23-25 April 2021.

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