DISCUSSION
The dermatological lesions related to Sars-CoV-2 infection most reported in children are maculopapular exanthema, urticarial lesions,8 erythema multiforme-like lesions,9 chilblain-like lesions,4,9 and varicella‐like lesions10 associated or not with pruritus and pain.4 They are similar to adults lesions and correspond to moderate to severe skin symptoms.2-4 However, the lesions presented by outpatients are not always exactly as previously reported. Mild cutaneous lesions as light exanthematous rash, localized rashes, isolated erythematous-edematous plaques, mild Pityriasis rosea, and petechiae in localized areas were seen in children and adults more frequently after the beginning of the pandemic at the dermatology clinic.
Is difficult to confirm the diagnosis when cutaneous lesions appear without significant systemic symptoms of COVID -19 by many reasons, being the main one the high frequency of false-negative RT-PCR and serologies for SARS-CoV-2.9 In addition, there is a refusal of the family to submit children to tests10 and the need for a broad viral panel to rule out other hypotheses.5 The clue to diagnosis is the close contact with a symptomatic adult and this information should be exhaustively sough.
The mild skin lesions do not require treatment in most cases. When treatment is necessary, short courses of topical corticosteroids associated with antihistamines in case of itching are enough.5 These cases corroborate the idea that children have a good prognosis and reinforce that the number of cases of COVID-19 is greater than the official statistics, especially in the pediatric population.
REFERENCES
3- Hedou M, Carsuzaa F, Chary E, Hainaut E, Cazenave-Roblot F, Masson Regnault M. Comment on "Cutaneous manifestations in COVID-19: a first perspective " by Recalcati S. J Eur Acad Dermatol Venereol 2020; 34(7):e299-e300.
https://doi.org/10.1111/jdv.16519 4- Galván Casas C, Català A, Carretero Hernández G, 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):71-77.
https://doi.org/10.1111/bjd.19163 5- de Medeiros VLS, Silva LFT. Follow-up of skin lesions during the evolution of COVID-19: a case report. [published online ahead of print September 20, 2016]. Arch Dermatol Res.
https://doi.org/10.1007/s00403-020-02091-0 7- Ludvigsson JF. Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults. Acta Paediatr 2020; 109:1088-1095.
https://doi.org/10.1111/apa.15270 8- Morey-Olivé M, Espiau M, Mercadal-Hally M, Lera-Carballo E, García-Patos V. Cutaneous manifestations in the current pandemic of coronavirus infection disease (COVID 2019). An Pediatr (Barc) 2020; 92(6):374-375.
https://dx.doi.org/10.1016%2Fj.anpede.2020.04.002 9- Torrelo A, Andina D, Santonja C, et al. Erythema multiforme-like lesions in children and COVID-19. Pediatr Dermatol 2020; 37:442–446.
https://doi.org/10.1111/pde.14246 10- Genovese, G., Colonna, C. and Marzano, A.V. Varicella‐like exanthem associated with COVID‐19 in an 8‐year‐old girl: A diagnostic clue?. Pediatr Dermatol 2020; 37:435-436.
https://doi.org/10.1111/pde.14201