Review Article - (2022) Volume 10, Issue 12
Skin symptoms of covid - 19 in children
Chhaya Wadhwani* and Pramita Muntode
*Correspondence: Dr. Chhaya Wadhwani, Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India, Email:
Abstract
Severe acute respiratory syndrome Coronavirus is responsible for the current Coronavirus pandemic. The first symptoms were respiratory, which progressed to severe respiratory distress, requiring ventilation in some cases and mortality in a small percentage of those affected. With the passage of time, new symptoms have surfaced. It's possible that the first it was Italian dermatologists who initially reported cutaneous findings. Coronaviruses (CoVs-2) are enclosed, single stranded, positive sense RNA viruses with helical symmetry nucleocapsids. People, animals and birds are all susceptible to infection. The Coronavirus can cause a cover a large area of symptoms in humans, ranging from the ordinary cold to life threatening infections.
Severe acute respiratory syndrome Coronavirus (Severe Acute Respiratory Syndrome-CoV-2) and the Middle East respiratory syndrome Coronavirus were previously identified as highly pathogenic and transmissible Coronavirus infections (Middle East respiratory syndrome). The new severe acute respiratory syndrome-CoV-2 induced disease first arose in December 2019 in Wuhan, China and quickly spread throughout the world, eventually becoming a disease spread over a whole country on March 11, 2020. The disease was formerly known in China as Wuhan pneumonia and it manifested itself with respiratory symptoms. Other symptoms were later identified as being involved.
Infection with SARS-CoV-2 in youngsters presents differently than it does in adults in terms of overall clinical presentation, course and outcome. COVID-19 cutaneous symptoms in children differ from those in adults. While certain signs like hives, flat and raised skin lesions or vesicular rash can affect people of all ages, others like chilblains, Erythema Multiform (EM) and cutis can affect people of all ages.
Keywords
Skin manifestations, Chilblains, Mucormycosis
Introduction
The Coronavirus epidemic has approached almost worldwide. The skin signs of COVID-19 in children are different from those in adults. COVID-19 symptoms include Erythema Multiforme (EM), urticaria and an inflammatory multisystem syndrome that is similar to Kawasaki Disease (KD).
Erythema multiforme: Erythema multiforme is an erythema that comes in a variety of shapes and sizes. EM is a self-limiting hypersensitivity condition characterized by erythematous lesions with symmetry known as iris or target lesions and a distinct skin eruption.
The two diseases most usually related with EM in kids are Mycoplasma pneumoniae, Herpes Zoster virus and Herpes simplex virus [1]. According to one report 7, a 18 year old girl exhibited separate papules over peripheral parts and target like appearance. An 8 years boy with target lesions over peripheral extremities and severe, painful chapped lips and conjunctivitis had a positive COVID-19 polymerase chain reaction result. In another investigation, skin tissues from patients had strong positive immunohistochemistry staining for SARS-CoV-2 [2].
Urticaria: Urticaria is characterized by pruritic, confined, raised weal that typically last between 24 and 48 hours. Allergens, dietary pseudo allergens, animal bites, medications and viruses, such as Parvovirus, Rhinovirus, Rotavirus, hepatitis A, B, C and Epstein-bar viruses are one of the most prevalent causes of urticaria in children.
In patients with coronaviruses, urticaria accounts for roughly 10%-20% of the cutaneous symptoms. Adults were the most commonly reported instances of urticaria in COVID-19, although children with urticaria were also documented and COVID-19 appears to be mainly asymptomatic except from the urticarial rash.
Viral infections can produce nonimmunological urticaria or vasculitis when the Coronavirus [3] binds to Angiotensin-Converting Enzyme (ACE-2) receptors on blood vessels, causing mast cell activation via complement. As a result, antibodies may bind to vascular walls, triggering an immunological.
Literature Review
Papulovesicular reactive rashes
Clinical features and association with Coronaviruses severity: Multicentre Italian case associated with intermediate Coronavirus severity was the first to report COVID-19 associated papulovesicular ex-anthem. A general polymorphism pattern, which is more prevalent and consists of small papules, vesicles and pustules of various sizes and a confined pattern, which is less common and consists of existing in only one form lesions, mainly involving the mid chest/upper abdomen region or the back, was discovered.
Livedo like lesions: One research of 380 COVID-19 verified cases found that with a 5 percentage point frequency, these lesions are one of the disease's least common symptoms. The trunk, flexor surface of the forearms, dorsal hand and dorsal foot were the most typically afflicted areas. The lesions appeared at the same time as the symptoms and primarily affected adults in their eighties and nineties. They generate livedo like lesions and are associated to major disorders that are characterized by hypercoagulable states that induce disseminated intravascular coagulation, macro thrombosis and micro thrombi.
Chilblains: These appeared as pain and itching in the acral region, primarily on the fingers and toes, followed erythematous to violaceous plaques. Children, teenagers and young adults will have the most lesions, which altered 1-4 weeks after the onset of systemic symptoms [4].
Small, itchy red spots on your skin, usually on your feet or hands, probable blistering or skin ulcers, skin swelling, burning sensation and changes in skin colour from red to dark blue, typically accompanied by discomfort.
Chilblains typically go away in one to three weeks, especially if the temperature warms up. For years, you may have seasonal recurrences. Protecting yourself from the cold and using lotions to relieve symptoms are both part of the treatment. Chilblains rarely cause long term damage. However, if left untreated, the condition can progress to infection, which can be fatal.
Globules, reticular network and background area were the three main traits found. The background colour in all circumstances. Globules, which are typically red to purple in colour, can be seen in most cases. Finally, the brown greyish reticular fibres can be found in around 30% of lesions and is most often found in the background. Tiny spots appear underneath the nail, dilated nail fold capillaries with loss of polarity and a sub-conjunctival haemorrhages dot have also been reported anecdotally.
A video capillaroscopy investigation was conducted on 19 teenagers in Italy. Even in situations where the skin lesions were localized to the lower limbs only, 16 capillary abnormalities of both the fingers and toes were described. The toes were more prone to pericapillary oedema and micro-haemorrhages.
These data could indicate that COVID-19 chilblains are caused by systemic rather than local mechanisms. Furthermore, these symptoms appear to be more severe than those seen in chilblains which arise suddenly that do not include small focal haemorrhages [5].
Treatment and final results: All of the children and adolescents who have had their cases reported so far have had a good outcome, with the lesions spontaneously resolving and no problems. Antihistamines and analgesics were only given on rare occasions. 16-18 in one example, gabapentin was taken orally to treat pain. In cases where there was an EM like eruption, 8 steroids were prescribed. Resolution timeframes have been reported to be anything from 12 days to more than 8 weeks. During this period, some individuals developed additional lesions, although the result was unaffected.
Infectious mononucleosis: Young children are less likely than adults to contract the Coronavirus Disease 2019 (COVID-19). In terms of clinical presentation, course and results, kid Coronavirus differs from adult’s Coronavirus. In many children who are infected with Coronavirus, the symptoms are modest. In kids with Coronavirus, cough cold and fever are the most common symptoms. Coronaviruses has a variety of skin symptoms in children. 3 In this paper, we describe an infectious mononucleosis like exanthema in a child as a putative COVID-19 related cutaneous manifestation.
Kawasaki disease: SARS-CoV-19 has recently been linked to Kawasaki syndrome 37, 38 as children acute vasculitis that can lead to cardiac disease and is primarily found in affluent nations. The incidence of endothelium damage linked to SARS-CoV-19 infection might be confirmed by such an association [6].
Oral lesion: According to the study, COVID-19 disease involves a variety of oral symptoms. Aphthous mouth ulcer, herpetiform lesions, fungal infection inflammation of vessels Kawasaki like, erythema multiforme like, mucositis, adverse drug reaction, necrotizing ulcerative gingivitis, angina bullos alike, angular stomatitis, atypical sweet syndrome and Melkersson syndrome are some of the most common manifestations.
Severe cutaneous drug eruption, Fuchs syndrome hypersensitivity reaction and other polymorphic/ atypical reactions. Severe acute respiratory syndrome Coronavirus infected in which hydroxychloroquine, a medicine previously identified as often related with AGEP, have been reported to develop AGEP. generalized pustular figuring is a subtype of the latter.
Urticarial rashes: Urticarial rash has been documented as occurring before or concurrently with the other usual infection symptoms, such as fever and cough, have also appeared, suggesting that it could be initial signs of severe acute respiratory syndrome Coronavirus infection. Urticaria being recorded several weeks after the onset of Coronavirus-19 symptoms in 45-51 people. In some of the most common case series, urticaria rates of 20/17/, on the overall observed skin reactions have been reported.
In both adults and children, acute and chronic urticaria has been linked to viral infections. As a result, COVID-19, like other respiratory viruses, could cause urticaria. On the other hand, it's impossible to rule out the possibility that urticarial reactions are caused by the medications employed in some circumstances.
Even though Galvan casas and colleagues discovered a more serious illness in thein the examined group displaying urticarial and maculopapular lesions, there appears to be no link between severity of COVID and urticaria does not appear to alter the prognosis.
Mucormycosis: Mucormycosis is the 3rd most popular prevalent invasive fungal infection in children, according to recent studies and its prevalence is increasing. It has a high case fatality rate, especially in neonates. Underlying risk factors influence clinical presentation; links to suppression of immunity, neutropenia, diabetes mellitus and preterm have been identified. It's been linked to a number of hospital epidemics.
Mucormycosis is a fungus that attacks both adults and children, generating severe morbidity and demise in both immuno compromised and immuno competent individuals.
Risk factors: Hemochromatosis, deferoxamine medication, injection of chemicals into body via hypodermic needle and kidney failure are all well-known causing factors, even if they are less common in children. Patients with no obvious immunodeficiency make up a major portion of the population; burns and sudden unplanned injury that can range for minor are particularly associated with skin of mucormycosis.
Clinical features: Rhino orbito cerebral infection, lung infection, cutaneous infection and gastrointestinal infection are the most common forms.
Cutaneous infection, which accounts for 20% of all cases and 28% of cases in kids, causes nonspecific inflammation that may or may not develop to the formation of a necrotic eschar. GGI and cutaneous disorders are more common in new-borns than in older children.
Diagnosis: In most cases, histopathology and culture are still utilised to provide a diagnosis, while molecular approaches are increasingly being employed to supplement older procedures. When compared to morphological identification of culture isolates, rapid molecular assay enhances species identification accuracy.
The accuracy of species identification is improved through testing. Nucleic acid amplification techniques have been used to amplify the gene cluster coding for rRNA targets 18 S, 28 S and in piece of non-functional RNA located between structural ribosomal RNA. The DNA extraction method utilised determines the specificity and sensitivity of molecular diagnostics performed on fresh frozen tissue.
Nosocomial mucormycosis: Infections caused by fungi in the class zygomycetes and order mucorales (Rhizopus, mucor and absidia) are well-known complications in patients with underlying blood cancer or immunosuppressive therapy, diabetes mellitus or thermal burns and in rare cases, in otherwise healthy people. The classic rhino cerebral type, invasive pulmonary or disseminated disease and an intestinal form are all common clinical manifestations. It's unusual to get a primary skin infection have presented a new epidemiologic link between contaminated Elastoplast ban and hospital acquired epidemic of skin and subcutaneous Rhizopus oryzae infection in six patients.
Treatment liposomal amphotericin penetrates the CNS more effectively than cAmB or ABLC, with fewer side effects. When given (at a dose of 3000 mcg/kg per day), liposomal amphotericin has evolved as the cornerstone of primary therapy for mucormycosis in patients with a hematologic malignancy and has been linked to improved outcomes in multivariate analysis when given to treat mucormycosis in patients with a blood malignancy.
In order to assure proper debridement and manage disease progression, cutaneous mucormycosis is expected to benefit from extensive surgical debridement [7].
Multisystem inflammatory syndrome: The heart, lungs, kidneys, brain, skin, eyes and gastrointestinal organs can all become inflamed in children (MIS-C). We don't know what causes MIS-C at this time. We do know, however, that many children with MIS-C had the virus that causes Coronavirus or had been exposed to someone who had it. Although MIS-C is a dangerous, even fatal illness, most children who have been identified with it have improved with medical treatment.
Because so much about MIS-C, including its source and risk factors, is unknown, it is classified as a syndrome a collection of symptoms and sign rather than a disease. Identifying and analysing more children with MIS-C may aid in the ultimate discovery of a cause. The centers for National Institutes of Health (NIH) and Disease Control and Prevention (CDC) a are collaborating with doctors and researchers from all around the country to learn more about MIS-C risk factors, share data and improve the following are symptoms and signs of Multisystem Inflammatory Syndrome in kids (MIS-C), albeit not all kids will experience the same findings. Fever, emesis, loose stools pain in abdomen, feeling lazy, fast heart rate, fast breathing, chemosis, swelling of lymph node, headache, oedema of the lips and tongue, oedema of lower limb headache, dizziness or light headedness [8].
Risk factors: In comparison to children of other races and ethnic groups, more black and Latino kid in the United States have been diagnosed with MIS-C. More research is needed to figure out why these youngsters are affected by MIS-C more frequently than other. Access to health information and services, as well as the likelihood of hereditary dangers, are all considerations to consider.
The majority of kids with multi system inflammatory syndrome have an average age of eight and range in age from three to twelve. Older children and babies have also been affected.
Prevention: Should be washed your hands often for at least 30 seconds with soap and water. If you don't have access to soap and water, use a hand sanitizer that has at least 60% alcohol. People who are ill should be avoided. Avoid persons who are coughing, sneezing or showing other indications of illness.
Distancing yourself from others is a good idea. When you and your child are outside of your house, always keep a space of at least 6 feet (2 metres) from other people. In public places, wear a cotton face mask. If your child is at least 3 years old, both you and your child should wear face shield that protect the nose and mouth when in indoor or outdoor public situations where there is a high risk of corruption coronavirus transmission, such as at a crowded event or large gathering.
Do not touch your nose and eyes ask your kid to follow your example and keep his or her hands away from his or her. When you sneeze or cough, cover your mouth with a tissue or an elbow. To avoid transmitting germs, you and your kid should practise covering your lips when sneezing or coughing.
High touch surfaces should be cleaned and disinfected on a daily basis. Towels, desktops, mouse, pencil, remote controls doors cupboards, handles, tables sink, toilet is all examples of this. Clothing and other items as needed. Use the hot water temperature on your washing machine, according to the manufacturer's guidelines. Washable soft toys should be included [9-14].
Discussion
The Severe acute respiratory syndrome-CoV-2 virus is spreader over the worldwide, infecting an increasing number of people. COVID-19 signs and symptoms are critical for early diagnosis because the virus can be spread even if no symptoms are present. The virus shows itself more moderately in youngsters and extra respiratory indications suggestive of a link to virus presentations can be seen. Drug responses, blood abnormalities and indications of other viral infections such as malaria, rubella and measles must all be cleared out before this link can be established [15-20].
There have been children who have diagnosed with a syndrome known as multisystem inflammatory syndrome, which includes symptoms that are similar to Kawasaki illness and overlaps with it (KD). A comprehensive evaluation of COVID-19 manifestations in children found that 12 (70.6 percent) of the 17 individuals (out of 114) showed signs of KD, a systemic vasculitis that is frequent in children under the age of five but rare after the age of eight and has an unknown cause. The polymorphic rash is the cutaneous manifestation and it includes erythema and oedema on the tongue, lips, oral mucosa, lingual papillae and cleft lip, among other symptoms. KD was discovered at the same time as COVID-19 was confirmed or shortly after [20-25].
Conclusion
The Severe acute respiratorysyndrome-CoV-2 epidemic has had a significant influence on healthcare, the economy and society and will almost certainly result in long term changes in our generation. Initially dismissed as insignificant, dermatological manifestations have shown to be diverse and complex. Recent efforts to characterize cutaneous involvement in COVID-19 patients, carried out in a study conducted quickly and rigorously in the midst of a full-fledged health emergency, have identified five distinct types of lesions (peripheral extremities, vesicular, urticarial, maculopapular and livedoid/dead lesions).
Chilblain like lesions were found all across the world while the COVID-19 outbreak was at its height. Patients with PCR detected illness, those with a possible Coronavirus infection and those with a Coronavirus relationship according to epidemiological evidence were all infected although COVID-19 has been definitively linked to chilblain lesions. It appears to have a good probability of happening.
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Author Info
Chhaya Wadhwani* and Pramita Muntode
Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, IndiaCitation: Chhaya Wadhwani, Pramita Muntode, Skin Symptoms of COVID-19 in Children, J Res Med Dent Sci, 2022, 10 (12): 137-141.
Received: 26-Sep-2022, Manuscript No. JRMDS-22-62075; , Pre QC No. JRMDS-22-62075(PQ); Editor assigned: 29-Sep-2022, Pre QC No. JRMDS-22-62075(PQ); Reviewed: 13-Oct-2022, QC No. JRMDS-22-62075; Revised: 25-Nov-2022, Manuscript No. JRMDS-22-62075(R); Published: 02-Dec-2022