Multidisciplinary management of a quickly growing pediatric atypical Spitz nevus, mimicking melanoma, during the COVID-19 pandemic

Spitzoid melanoma is very rare tumour in the pediatric population, with clinical and non-uniform behaviour, different from adult melanoma [1]. It can be difficult to differentiate an atypical Spitz nevus from a Spitzoid melanoma, resulting in diagnostic problems. In addition, in our clinical case, the COVID-19pandemiccaused significant delays both in the diagnosis and in the surgical treatment of our patient. We present the clinical case of a 4-year-old child suffering from a localized polypoid cutaneous neoformation on the dorsum of the left hand, which started immediately before the lockdown and steadily increased during the COVID-19 pandemic. After a general clinical framing, the child underwent an excisional biopsy at our Department of Plastic and Reconstructive Surgery, at the Policlinico of Foggia. Subsequently, two independent anatomic pathology groups examined the specimen. Definitive diagnosis was made only after careful genetic analysis in combination with supporting histological and immunohistochemical examinations. This clinical case shows how during the pandemic we have been facing advanced forms of tumours, compared to the previous period and highlight show an interdisciplinary and multicenter collaboration allowed a quick diagnosis of certainty, demonstrating the utility of molecular pathology as a fundamental aid in clinical/surgical practice. © 2022 The Authors

Chilblain-like lesions (COVID-19 toes) have the same impact on family members than psoriasis systemically treated: insights from a case-control study targeting the pediatric population.

OBJECTIVE: COVID-19 toes represent the main dermatological COVID-19 cutaneous manifestation in pediatric patients. Its diagnosis exposes the whole family to social stigma and this aspect was not previously evaluated. PATIENTS AND METHODS: This was a multicenter, case-control, observational study that compared the family impact of COVID-19 toes vs. psoriasis (PsO). We enrolled 46 pediatric patients (23 with psoriasis and 23 with COVID-19 toes, age and gender matched) and their parents/caregivers that had to fill the Dermatitis Family Impact (DFI) questionnaire. RESULTS: DFI index did not differ significantly between both subgroups (p=0.48), and in psoriatic patients did not correlate with both Psoriasis Area Severity Index (PASI) (p=0.59) and itch-VAS (p=0.16). CONCLUSIONS: COVID-19 toes, a transitory dermatosis, exerted a similar impact/perturbation on family dynamics than PsO, a well-known stigmatizing, chronic inflammatory dermatosis.

Differential diagnosis of pediatric dermatology

COVID toes, which were identified for the first time in April 2020 in Italy (1), are very similar to idiopathic chilblains and must be differentiated from the latter. The causal link of COVID toes with the current SARS-CoV-2 pandemic is not evidenced in most cases by the positivity of laboratory investigations. However, it is made probable by their maximum incidence during pandemic peaks even in the absence of cold, by relapses in the same subject during the different pandemic waves, and by their occurrence following mRNA vaccination for COVID-19. © 2021 Dermatologia Pediatrica. All rights reserved.

An unusual pseudomelanosis in toddlers

An unusual brownish pigmentation of the pelvis and lower limbs in infants which can be easily removed with a towel, to reappear after a few hours was described. The arcane clarifies when a manufacturer of baby cleaning wipes withdrew a lot from the market, holding it responsible for the phenomenon.

Erythema multiforme in time of COVID-19

Erythema multiforme is a skin reaction to numerous factors, the best known of which is Herpes simplex virus. The child of the current report in full SARS-CoV-2 pandemic presented after flu symptoms characteristic vasculitic lesions of the feet and after a few days erythema multiforme. The authors of the current report suggest a probable relationship of these symptoms with COVID-19.

Acral rash in a child with COVID-19

A 9-year-old boy suffering from COVID-19 presented after an acute conjunctivitis, symptomatic glossitis, cheilitis, then reticular livedo, urticaria angioedema and finally a palmar-plantar scarlet fever-like rash. These COVID-19 symptoms observed consecutively in the same child have been described in isolation among the cutaneous manifestations of COVID-19. The authors discuss the pathogenesis of these late symptoms of SARS-CoV-2 infection.

Inflammatory Skin Lesions in Three SARS-CoV-2 Swab-Negative Adolescents: A Possible COVID-19 Sneaky Manifestation?

Coronavirus disease 19 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is associated with various clinical manifestations, including skin lesions. In particular, during the COVID-19 pandemic lock-down period numerous chilblain-like lesions, mainly located on the feet, were observed in adolescents. The latter were often asymptomatic or associated with very mild respiratory symptoms. Here, we report three cases of acral nodular lesions in SARS-CoV-2 swab-negative adolescents with histological findings of chronic immune-mediated inflammation and immunohistochemical evidence of SARS-CoV-2 spike glycoproteins in endothelial cells and eccrine sweat glands. In one of these cases, the virus presence was confirmed by electron microscopy.

Granuloma annulare and SARS-CoV-2 pandemic

Granuloma annulare is a disease with well-defined and constant clinical characteristics, although it can be caused by multiple factors. Among the latter the most frequent are viral agents. Based on the history, some of its clinical oddities in time of COVID-19 and some pathogenetic and histological similarities with vasculitis induced by SARS-CoV-2 the Authors believe that granuloma annulare at the time of COVID-19 in some cases may be due to SARS-CoV-2. © 2020 Dermatologia Pediatrica. All rights reserved.

A new vasculitis at the time of COVID-19

The authors describe a vasculitis observed for the first time during the COVID-19 pandemic, which affected children towards the end of the first decade of life and teenagers, however, in good health, prevailed on the feet and resembled chilblains, but in the absence of exposure to the cold and predisposing constitutional factors. When it was possible to perform swabs and serological tests these were often negative;the probable relationship with COVID-19 was based on the history, on the concomitance between lesions never observed previously and a new infection, on the presence of vasculitic lesions of the same type but much more serious in patients with severe forms of COVID-19.

Acute acro-ischemia in the child at the time of COVID-19

5 weeks after the diagnosis of the first autochthonous case of COVID-19 in Italy - February, 20 2020 - the authors reported that children and adolescents otherwise in good health were suffering from acroischemic foot lesions. The lesions, which were reminiscent of chilblains, were often painful and evolved within a few weeks with restitutio ad integrum. The lesions were probably the expression of vascular disorders related to SARS-CoV-2 infection.

Skin manifestations of COVID-19 in children: Part 1.

The current COVID-19 pandemic is caused by the SARS-CoV-2 coronavirus. The initial recognized symptoms were respiratory, sometimes culminating in severe respiratory distress requiring ventilation, and causing death in a percentage of those infected. As time has passed, other symptoms have been recognized. The initial reports of cutaneous manifestations were from Italian dermatologists, probably because Italy was the first European country to be heavily affected by the pandemic. The overall clinical presentation, course and outcome of SARS-CoV-2 infection in children differ from those in adults as do the cutaneous manifestations of childhood. In this review, we summarize the current knowledge on the cutaneous manifestations of COVID-19 in children after thorough and critical review of articles published in the literature and from the personal experience of a large panel of paediatric dermatologists in Europe. In Part 1, we discuss one of the first and most widespread cutaneous manifestation of COVID-19, chilblain-like lesions. In Part 2, we review other manifestations, including erythema multiforme, urticaria and Kawasaki disease-like inflammatory multisystemic syndrome, while in Part 3, we discuss the histological findings of COVID-19 manifestations, and the testing and management of infected children, for both COVID-19 and any other pre-existing conditions.