Cutaneous and histopathological features of coronavirus disease 2019 in pediatrics: A review article

Prevalence of dermatological manifestations of coronavirus disease 2019 (COVID-19) is estimated between 0.25% and 3% in children and adolescents. In this review article, we decided to describe the cutaneous and histopathological manifestations of COVID-19 infection in pediatrics. We searched published articles in PubMed database for key words of "children" or "pediatric" and "cutaneous" or "dermatology" or "skin" and "COVID-19" or "SARS-CoV-2" or "Coronavirus disease 2019" in abstract or title from December of 2019 until September 2020. Finally, 38 articles were selected. The majority of patients were between 11 and 17 years old with predominantly male gender. Most of the patients were either asymptomatic or had a few general symptoms. The latency time from appearance of general symptoms to cutaneous ones was between 1 day and weeks. Skin lesions faded between 3 and 88 days without any sequelae, spontaneously or with either topical or systemic corticosteroids. Skin manifestations were chilblain-like (pseudochilblain), erythema multiforme-like, dactylitis, acral erythema, acute urticaria, livedo reticularis, mottling, acro-ischemia, generalized maculopapular lesions, eyelid dermatitis, miliaria-like, varicelliform lesions, and petechiae and/or purpura. Kawa-COVID-19 patients were presented more frequently with cardiogenic shock, neurological symptoms, lymphocytopenia, and thrombocytopenia as compared to classic Kawasaki's disease. Furthermore, more number of cases were resistant to the first-line treatments.