DOI: http://dx.doi.org/10.18203/issn.2455-4529.IntJResDermatol20221201

Retrospective study on mucocutaneous manifestations due to COVID-19 in paediatric age group in a tertiary care centre in Southern India

Priyavathani Annie Malathy, Thamizhselvi S., Poornima H. R.

Abstract


Background: COVID-19 virus is known to cause wide variety of mucocutaneous manifestations . The inflammatory response of body plays a crucial role in SARS-CoV-2 induced lung injury.These cytokines arriving at the skin and reaching various cells of cutaneous immune system can cause dermatological lesions described during COVID-19 infection.The primary aim of this study is to characterize the diversity of cutaneous manifestations due to COVID-19 in pediatric age group.

Methods: The study was an observational study done on paeadiatric COVID cases aged less than 12 years who were admitted in COVID isolation ward of Institute of Child Health, Rajiv Gandhi Government General Hospital. This study was conducted for 3 months from August 2020 to October 2020.

Results: A total of 191 swab-confirmed cases of COVID-19 aged less than 12 years were recruited in the study. Out of 191 cases, 19 had dermatological manifestations (10%).The most common type of dermatological manifestation noted in our study was maculopapular rash (N=8) , followed by purpura (N=4),urticarial (N=3), angular cheilitis (N=2), palmar erythema (N=1), purpura with palmar erythema occurring together (N=1). Time latency between onset of first COVID symptom and occurrence of cutaneous lesion was 1 to 7 days.

Conclusions: A total of 191 swab-confirmed cases of COVID-19 aged less than 12 years were recruited in the study. Out of 191 cases, 19 had dermatological manifestations (10%). The most common type of dermatological manifestation noted in our study was maculopapular rash (N=8) , followed by purpura (N=4),urticarial (N=3), angular cheilitis (N=2), palmar erythema (N=1), purpura with palmar erythema occurring together (N=1). Time latency between onset of first COVID symptom and occurrence of cutaneous lesion was 1 to 7 days.


Keywords


COVID-19, Mucocutaneous, Multisystem inflammatory syndrome in children, Kawasaki

Full Text:

PDF

References


Daneshgaran G, Dubin DP, Gould DJ. Cutaneous Manifestations of COVID-19: An Evidence-Based Review. Am J Clin Dermatol. 2020;1-13.

Recalcati S. Cutaneous manifestations in COVID-19: a first perspective. J Eur Acad Dermatol Venereol. 2020;34(5):e212-3.

Li G, Fan Y, Lai Y, Han T, Li Z, Zhou P, et al. Coronavirus infections and immune responses. J Med Virol. 2020;92(4):424-32.

Angiotensin-converting enzyme 2 (ACE2), SARS-CoV-2 and the pathophysiology of coronavirus disease 2019 (COVID-19). 2021.

Kaya G, Kaya A, Saurat J-H. Clinical and Histopathological Features and Potential Pathological Mechanisms of Skin Lesions in COVID-19: Review of the Literature. Dermatopathol. 2020;7(1):3-16.

Nakra NA, Blumberg DA, Herrera-Guerra A, Lakshminrusimha S. Multi-System Inflammatory Syndrome in Children (MIS-C) Following SARS-CoV-2 infection: review of clinical presentation, hypothetical pathogenesis, and proposed management. Children. 2020;7(7):45-9.

Radia T, Williams N, Agrawal P, Harman K, Weale J, Cook J, et al. Multi-system inflammatory syndrome in children and adolescents (MIS-C): A systematic review of clinical features and presentation. Paediatr Respir Rev. 2020;2:34-9.

Ahmed M, Advani S, Moreira A, Zoretic S, Martinez J, Chorath K, et al. Multisystem inflammatory syndrome in children: A systematic review. Clin Med. 2020.

Marraha F, Al Faker I, Gallouj S. A Review of the Dermatological Manifestations of Coronavirus Disease 2019 (COVID-19). Dermatol Res Pract. 2020;2020:93-9.

Multisystem inflammatory syndrome in children and adolescents with COVID-19. Available at: https://www.who.int/publications-detail-redirect/ multisystem-inflammatory-syndrome-in-children-and-adolescents-with-covid-19. Accessed on 20 October 2021.

Fernandez-Nieto D, Jimenez-Cauhe J, Suarez-Valle A, Moreno-Arrones OM, Saceda-Corralo D, Arana-Raja A, et al. Characterization of acute acral skin lesions in nonhospitalized patients: A case series of 132 patients during the COVID-19 outbreak. J Am Acad Dermatol. 2020;83(1):e61-3.

Piccolo V, Neri I, Filippeschi C, Oranges T, Argenziano G, Battarra VC, et al. Chilblain like lesions during COVID-19 epidemic: a preliminary study on 63 patients. J Eur Acad Dermatol Venereol. 2020;32:231-8.

Freeman EE, McMahon DE, Lipoff JB, Rosenbach M, Kovarik C, Takeshita J, et al. Pernio-like skin lesions associated with COVID-19: A case series of 318 patients from 8 countries. J Am Acad Dermatol. 2020;83(2):486-92.

Bouaziz J, Duong T, Jachiet M, Velter C, Lestang P, Cassius C, et al. Vascular skin symptoms in COVID-19: a french observational study. J Eur Acad Dermatol Venereol. 202;12:56-9.

de Masson A, Bouaziz J-D, Sulimovic L, Cassius C, Jachiet M, Ionescu M-A, et al. Chilblains is a common cutaneous finding during the COVID-19 pandemic: A retrospective nationwide study from France. J Am Acad Dermatol. 2020;83(2):667-70.

Marzano AV, Genovese G, Fabbrocini G, Pigatto P, Monfrecola G, Piraccini BM, et al. Varicella-like exanthem as a specific COVID-19–associated skin manifestation: Multicenter case series of 22 patients. J Am Acad Dermatol. 2020;83(1):280-5.

Diaz-Guimaraens B, Dominguez-Santas M, Suarez-Valle A, Pindado-Ortega C, Selda-Enriquez G, Bea-Ardebol S, et al. Petechial Skin Rash Associated With Severe Acute Respiratory Syndrome Coronavirus 2 Infection. JAMA Dermatol. 2020; 156(7):820-2.

Sanchez A, Sohier P, Benghanem S, L’Honneur A-S, Rozenberg F, Dupin N, et al. Digitate Papulosquamous Eruption Associated With Severe Acute Respiratory Syndrome Coronavirus 2 Infection. JAMA Dermatol. 2020;156(7):819-20.

Magro C, Mulvey JJ, Berlin D, Nuovo G, Salvatore S, Harp J, et al. Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: A report of five cases. Transl Res. 2020;220:1-13.

Zhang Y, Cao W, Xiao M, Li YJ, Yang Y, Zhao J, et al. Clinical and coagulation characteristics of 7 patients with critical COVID-2019 pneumonia and acro-ischemia.. JAMA Dermatol. 2020;41(0):E006.

Singh H, Kaur H, Singh K, Sen CK. Cutaneous Manifestations of COVID-19: A Systematic Review. Adv Wound Care. 2021;10(2):51-80.

Andina D, Belloni-Fortina A, Bodemer C, Bonifazi E, Chiriac A, Colmenero I, et al. Skin manifestations of COVID-19 in children: Part 1. Clin Exp Dermatol. 2021;46(3):444-50.

Rerknimitr P, Theerawattanawit C, Lertpichitkul P, Jantarabenjakul W, Putcharoen O, Puthanakit T, et al. Skin manifestations in COVID-19: The tropics experience. J Dermatol. 2020;47(12):e444-6.

Kaya G, Kaya A, Saurat J-H. Clinical and histopathological features and potential pathological mechanisms of skin lesions in COVID-19: review of the literature. Dermatopathology. 2020;7(1):3-16.

Mirza FN, Malik AA, Omer SB, Sethi A. Dermatologic manifestations of COVID-19: a comprehensive systematic review. Int J Dermatol. 2021;60(4):418-50.

Galván Casas C, Català A, Carretero Hernández G, Rodríguez-Jiménez P, Fernández-Nieto D, Rodríguez-Villa Lario A, et al. Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases. Br J Dermatol. 2020;183(1):71-7.

Lee PY, Day-Lewis M, Henderson LA, Friedman KG, Lo J, Roberts JE, et al. Distinct clinical and immunological features of SARS–CoV-2–induced multisystem inflammatory syndrome in children. J Clin Invest. 2020;130(11):5942-50.

Shioji N, Aoyama K, Englesakis M, Annich G, Maynes JT. Multisystem inflammatory syndrome in children during the coronavirus disease pandemic of 2019: a review of clinical features and acute phase management. J Anesth. 2021;30:1-8.

Young TK, Shaw KS, Shah JK, Noor A, Alperin RA, Ratner AJ, et al. Mucocutaneous Manifestations of Multisystem Inflammatory Syndrome in Children During the COVID-19 Pandemic. JAMA Dermatol. 2021;157(2):207.

Naka F, Melnick L, Gorelik M, Morel KD. A dermatologic perspective on multisystem inflammatory syndrome in children. Clin Dermatol. 2021;39(1):163-8.

Chaudhary H, Mohan M, Jain A, Kumar V, Takia L, Sudhakar M, et al. Acral gangrene: ugly cousin of “covid toes” in multisystem inflammatory syndrome in children associated with SARS-COV-2?. Pediatr Infect Dis J. 2021;76:675-9.

Abrams JY, Oster ME, Godfred-Cato SE, Bryant B, Datta SD, Campbell AP, et al. Factors linked to severe outcomes in multisystem inflammatory syndrome in children (MIS-C) in the USA: a retrospective surveillance study. Lancet Child Adolesc Health. 2021;5(5):323-31.