Cutaneous, Histopathologic Features of COVID-19 in Children Identified

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Cutaneous and histopathologic manifestations of COVID-19 infection in a pediatric population are described.

Common skin manifestations observed in children and adolescents with coronavirus disease 2019 (COVID-19) include acute urticaria, mottling, generalized maculopapular lesions, eyelid dermatitis, varicelliform lesions, and rash, according to study findings published in Dermatologic Therapy.

A team of researchers from Iran evaluated the cutaneous and histopathological manifestations of COVID-19 in pediatric patients in a series of articles, including case series and case reports, published from December 2018 to September 2020.

The retrospective study included 38 articles comprising 353 pediatric patients with COVID-19. The majority of patients were boys (58.4%) vs girls (41.6%). Most patients were between 11 and 17 years of age.

Overall, the most common skin manifestations in these patients were chilblain-like (pseudo-chilblain), EM-like, dactylitis, acral erythema, acute urticaria, livedo reticularis, mottling, acro-ischemia, generalized maculopapular lesions, eyelid dermatitis, miliaria-like, varicelliform lesions, and rash with petechiae and purpura.

In cases of symptomatic disease, the latency time from the appearance of general symptoms to cutaneous manifestations was from1 day to a few weeks. General symptoms appeared after cutaneous manifestations in 3 patients and appeared simultaneously in 2 cases. According to the investigators, skin lesions reported in the articles improved from 3 to 88 days without sequelae.

Limitations of this study were the relatively small sample size, the retrospective nature, and the lack of a non-COVID-19 control group.

The researchers noted in their study that concurrent with the pandemic was a sudden uptick in the prevalence of Kawasaki-like disease (Kawa-COVID-19), Kawasaki disease shock syndrome, macrophage activation syndrome, and multisystem inflammatory syndrome in children. Cardiogenic shock, pericarditis, myocarditis, neurological symptoms, lymphocytopenia, and thrombocytopenia were reported more frequently in patients with suspected COVID-19 compared with patients with classic Kawasaki disease.


Khalili M, Iranmanesh B, Mohammadi S, Aflatoonian M. Cutaneous and histopathological features of Coronavirus disease 2019 in pediatrics: A review article. Published online November 18, 2020. Dermatol Ther. doi:10.1111/dth.14554