Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy.
School of Pediatrics, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
Eur J Pediatr. 2022 Oct;181(10):3577-3593. doi: 10.1007/s00431-022-04585-7. Epub 2022 Aug 10.
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.
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.
• 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.
• 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.
本系统综述旨在确定排除儿童多系统炎症综合征（MIS-C）后，与 COVID-19 相关的新生儿、儿童和青少年出现的皮肤表现的类型、发生率、发病时间和演变。
使用专门的字符串在 PubMed、Tripdatabase、ClinicalTrials 和 Cochrane Library 数据库中搜索病例报告/系列和观察性研究，检索时间为 2019 年 12 月至 2022 年 2 月。使用 STROBE 和 CARE 工具评估研究质量。
在 26545 篇确定的文章中，有 73 篇（49 篇病例报告/系列和 24 篇研究）被纳入分析。皮肤病变的临床表现、发病时间和与其他 COVID-19 表现的关联高度异质。总体而言，它们主要影响四肢末端，且通常表现出良好的结局。假性冻疮样疹是最常见的。
黏膜皮肤表现可能是 COVID-19 的唯一/主要且早期表现，可能比其他更严重的表现提前数天或数周出现。因此，所有学科的医生都应该熟悉这些表现。
