








key: cord-338754-xdid58vn
authors: Olisova, O. Yu; Anpilogova, E.M.; Shnakhova, L.M.
title: Cutaneous manifestations in COVID‐19: a skin rash in a child
date: 2020-05-30
journal: Dermatol Ther
DOI: 10.1111/dth.13712
sha: 
doc_id: 338754
cord_uid: xdid58vn

nan

symptoms in children are fever, dry cough, fatigue, sometimes respiratory or gastrointestina l symptoms 3 . Dr Recalcati made the first report on cutaneous manifestations in COVID-19 nearly a month ago 4 , and since then, several authors have also noticed COVID-19-associated skin rash in adults [5] [6] [7] [8] [9] .

According to them, skin symptoms may include erythematous rash, localized or widespread urticaria, chicken-pox-like lesions, vascular lesions and dengue-like rash. The trunk and the limbs are reported to be the most commonly involved sites. However, the data on COVID-19-associated skin disorders in children are scarce.

We observed that a 12-year-old girl who was confined to her home in Moscow due to COVID-19 self-isolation in mid-April had a fever of 38.2°C for 2 consecutive days. No clinical symptoms of any bacterial or viral infection were noted except for fatigue and headache. On the second day of fever the PCR COVID-19 test was positive. The general blood test was normal except for elevated C-reactive protein level and erythrocyte sedimentation rate. Chest CT scan revealed no pulmona r y changes. The patient was most likely infected by her COVID-positive mother, who is a nurse looking after many COVID-19 patients. The treatment was unspecific and consisted of paracetamol. On the third day of illness the fever dramatically ceased and the skin rash appeared.

On examination we noted purpuric eruptions and erythematous macula rashes of 3 to 4 mm size mainly on the upper eyelids, above the eyebrows and in temporal region (Figure 1 ). Besides that, her tongue was slightly swollen and irritated with pronounced lingual papillae ( Figure 2 ). The described eruptions were asymptomatic and completely disappeared within three days without treatment.

Our observation confirms the idea that the COVID-19 infectious syndrome not infrequent l y includes different types of skin rashes and as seen in this first description with a rare involveme nt of the oral mucous membranes. Along with fever and fatigue, these eruptions may be considered as the only clinical manifestation of these particular COVID-19 infections in children. This could be due to CD8 hyperexpression, which participates in antiviral immunity 10 .

We think it is important to monitor the skin not only in adults but also in children who can transmit this virus asymptomatically. In the case of any skin alterations we would strongly recommend that a nasopharyngeal and oropharyngeal swab is performed to confirm the possible COVID-19 diagnosis and in this way break the chain of transmission immediately.

This article is protected by copyright. All rights reserved. 

This article is protected by copyright. All rights reserved.

Novel coronavirus: where we are and what we know

Updated diagnosis, treatment and prevention of COVID-19 in children: experts' consensus statement (condensed version of the second edition)

Cutaneous manifestations in COVID-19: a first perspective

Cutaneous manifestations in COVID-19: Lessons learned from current evidence

Cutaneous manifestations in COVID-19: the experiences of Barcelona and Rome

Acute urticaria with pyrexia as the first manifestations of a COVID-19 infection

COVID-19 can present with a rash and be mistaken for dengue

Cutaneous Signs in COVID-19 Patients: A Review

The patients in this manuscript have given written informed consent to the publication of their case details.

