Manifestações cutâneas da COVID-19 em crianças e adolescentes: uma revisão sistemática

Contribuição dos autores

Desenho do estudo: Pasquini Neto R, Mazzo FAT, Vieira FA, Bueno GS, Previdi JVC, Silva LR, Silva NKB. Coleta de dados: Pasquini Neto R, Mazzo FAT, Vieira FA, Bueno GS, Previdi JVC, Silva LR, Silva NKB. Análise dos dados: Pasquini Neto R, Mazzo FAT, Vieira FA, Bueno GS, Previdi JVC, Silva LR, Silva NKB. Redação do manuscrito: Pasquini Neto R, Mazzo FAT, Vieira FA, Bueno GS, Previdi JVC, Silva LR, Silva NKB. Revisão do manuscrito: Pasquini Neto R, Mazzo FAT, Vieira FA, Bueno GS, Previdi JVC, Silva LR, Silva NKB, Cerci FB, Jorizzo JL. Supervisão do estudo: Cerci FB, Jorizzo JL.

Manifestações cutâneas	Referências	País	Número de pacientes e sexo	Idade média dos pacientes (anos)	Local da lesão	Tempo médio até a manifestação da lesão (dias)	Duração da lesão (dias)
Lesão tipo Chilblain	⁸8 Mazzotta F, Troccoli T. Acute acro-ischemia in the child at the time of COVID-19. Eur J Pediat Dermatol. 2020;30:71-4. https://doi.org/10.26326/2281-9649.30.2.2102 https://doi.org/10.26326/2281-9649.30.2.... –¹⁴14 Colonna C, Monzani NA, Rocchi A, Gianotti R, Boggio F, Gelmetti C. Chilblain-like lesions in children following suspected COVID-19 infection. Pediatr Dermatol. 2020;37:437-40. https://doi.org/10.1111/pde.14210 https://doi.org/10.1111/pde.14210...	Itália	33 Mulheres 55 Homens	11.7	88 Extremidades	13.9	8.1
	¹⁵15 Serrano JM, Monferrer JC, García-Gil MF. Acro-ischemic skin lesions during COVID-19 epidemic. Semergen. 2020;46:103-5. https://doi.org/10.1016/j.semerg.2020.05.003 https://doi.org/10.1016/j.semerg.2020.05... –²²22 Garcia-Lara G, Linares-González L, Ródenas-Herranz T, Ruiz-Villaverde R. Chilblain-like lesions in pediatrics dermatological outpatients during the COVID-19 outbreak. Dermatol Ther. 2020;33:13516. https://doi.org/10.1111/dth.13516 https://doi.org/10.1111/dth.13516...	Espanha	58 Mulheres 95 Homens	13.4	153 Extremidades	7	18
	²³23 Cordoro KM, Reynolds SD, Wattier R, McCalmont TH. Clustered cases of acral perniosis: clinical features, histopathology, and relationship to COVID-19. Pediatr Dermatol. 2020;37:419-23. https://doi.org/10.1111/pde.14227 https://doi.org/10.1111/pde.14227...	Estados Unidos	1 Mulher 5 Homens	15	6 Extremidades	7	Não mencionado
	²⁴24 Schnapp A, Abulhija H, Maly A, Armoni-Weiss G, Levin Y, Faitatziadou SM, et al. Introductory histopathological findings may shed light on COVID-19 paediatric hyperinflammatory shock syndrome. J Eur Acad Dermatol Venereol. 2020;34:665-7. https://doi.org/10.1111/jdv.16749 https://doi.org/10.1111/jdv.16749...	Israel	1 Homem	16	1 Extremidade	Não mencionado	Não mencionado
	²⁵25 Rafai M, Elbenaye J, Sabry S, Janah H. Delayed hypersensitivity as a pathophysiological mechanism in cutaneous lesions due to SARS-CoV-2. Pan Afr Med J. 2020;35:115. https://doi.org/10.11604/pamj.supp.2020.35.2.24980 https://doi.org/10.11604/pamj.supp.2020....	Marrocos	1 Homem	17	1 Extremidade	4	Não mencionado
Lesão tipo eritema multiforme	²⁶26 Maniaci A, Iannella G, Vicini C, Pavone P, Nunnari G, Falsaperla R, et al. A Case of COVID-19 with late-onset rash and transient loss of taste and smell in a 15-year-old boy. Am J Case Rep. 2020;21:925813. https://doi.org/10.12659/AJCR.925813 https://doi.org/10.12659/AJCR.925813... –²⁸28 Piccolo V, Neri I, Filippeschi C, Oranges T, Argenziano G, Battarra VC, et al. Chilblain-like lesions during COVID-19 epidemic: a preliminary study on 63 patients. J Eur Acad Dermatol Venereol. 2020;34:291-3. https://doi.org/10.1111/jdv.16526 https://doi.org/10.1111/jdv.16526...	Itália	38 Mulheres 45 Homens	14	63 Extremidades 1 Generalizada	9.9	Não mencionado
	²²22 Garcia-Lara G, Linares-González L, Ródenas-Herranz T, Ruiz-Villaverde R. Chilblain-like lesions in pediatrics dermatological outpatients during the COVID-19 outbreak. Dermatol Ther. 2020;33:13516. https://doi.org/10.1111/dth.13516 https://doi.org/10.1111/dth.13516... , ²⁹29 Morey-Olivé M, Espiau M, Mercadal-Hally M, Lera-Carballo E, García-Patos V. Manifestaciones cutáneas en contexto del brote actual de enfermedad por coronavirus 2019. An Pediatr (Barc). 2020;92:377-8. https://doi.org/10.1016/j.anpedi.2020.04.013 https://doi.org/10.1016/j.anpedi.2020.04... –³¹31 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 (Engl Ed). 2020;92:374-5. https://doi.org/10.1016/j.anpede.2020.04.002 https://doi.org/10.1016/j.anpede.2020.04...	Espanha	5 Mulheres 5 Homens	9.6	2 Extremidades 8 Generalizada	9	10.4
	³²32 Patek P, Corcoran J, Adams L, Khandhar P. SARS-CoV-2 infection in a 2-week-old male with neutropenia. Clin Pediatr (Phila). 2020;59:918-20. https://doi.org/10.1177/0009922820920014 https://doi.org/10.1177/0009922820920014... , ³³33 Wolfe DM, Nassar GN, Divya K, Krilov LR, Noor A. Young children presenting with fever and rash in the midst of SARS-CoV-2 outbreak in New York. Clin Pediatr (Phila). 2020;59:1112-8. https://doi.org/10.1177/0009922820941631 https://doi.org/10.1177/0009922820941631...	Estados Unidos	2 Homens 1 Mulher	2.3	3 Extremidades	9	Não mencionado
	³⁴34 Pouletty M, Borocco C, Ouldali N, Caseris M, Basmaci R, Lachaume N, et al. Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 mimicking Kawasaki disease (Kawa-COVID-19): a multicentre cohort. Ann Rheum Dis. 2020;79:999-1006. https://doi.org/10.1136/annrheumdis-2020-217960 https://doi.org/10.1136/annrheumdis-2020...	França	8 Mulheres 8 Homens	10	Não mencionado	Não mencionado	Não mencionado
	³⁵35 Yozgat CY, Uzuner S, Duramaz B, Yozgat Y, Erenberk U, Iscan A, et al. Dermatological manifestation of pediatrics multisystem inflammatory syndrome associated with COVID-19 in a 3-year-old girl. Dermatol Ther. 2020;33:13770. https://doi.org/10.1111/dth.13770 https://doi.org/10.1111/dth.13770...	Turquia	1 Mulher	3	1 Generalizada	5	Não mencionado
	³⁶36 Ng SM. Prolonged dermatological manifestation 4 weeks following recovery of COVID-19 in a child. BMJ Case Rep. 2020;13:237056. https://doi.org/10.1136/bcr-2020-237056 https://doi.org/10.1136/bcr-2020-237056... , ³⁷37 Klimach A, Evans J, Stevens J, Creasey N. Rash as a presenting complaint in a child with COVID-19. Pediatr Dermatol. 2020;37:966-7. https://doi.org/10.1111/pde.14257 https://doi.org/10.1111/pde.14257...	Reino Unido	2 Homens	12.5	2 Generalizada	21.5	13
	³⁸38 Navaeifar MR, Ghazaghi M, Shahbaznejad L, Rouhanizadeh H, Abutalebi M, Varandi M, et al. Fever with rash is one of the first presentations of COVID-19 in children: a case report. Int Med Case Rep J. 2020;13:335-40. https://doi.org/10.2147/IMCRJ.S262935 https://doi.org/10.2147/IMCRJ.S262935...	Irã	1 Homem	1	1 Generalizada	2	11
	³⁹39 Olisova OY, Anpilogova EM, Shnakhova LM. Cutaneous manifestations in COVID-19: a skin rash in a child. Dermatol Ther. 2020;33:13712. https://doi.org/10.1111/dth.13712 https://doi.org/10.1111/dth.13712...	Rússia	1 Mulher	12	1 Generalizada	3	3
Lesão tipo varicela	⁴⁰40 Genovese G, Colonna C, Marzano AV. Varicella-like exanthem associated with COVID-19 in an 8-year-old girl: a diagnostic clue? Pediatr Dermatol. 2020;37:435-6. https://doi.org/10.1111/pde.14201 https://doi.org/10.1111/pde.14201... , ⁴¹41 Marzano AV, Genovese G, Fabbrocini G, Pigatto P, Monfrecola G, Piraccini BM, et al. Varicella-like exanthem as a specific COVID-19-associated skin manifestation: Multicenter case series of 22 patients. J Am Acad Dermatol. 2020;83:280-5. https://doi.org/10.1016/j.jaad.2020.04.044 https://doi.org/10.1016/j.jaad.2020.04.0...	Itália	1 Mulher 1 Homem	8	2 Generalizada	4	7
Lesão tipo varicela	⁴²42 Aghazadeh N, Homayouni M, Sartori-Valinotti JC. Oral vesicles and acral erythema: report of a cutaneous manifestation of COVID-19. Int J Dermatol. 2020;59:1153-4. https://doi.org/10.1111/ijd.15047 https://doi.org/10.1111/ijd.15047...	Irã	1 Mulher	9	1 Generalizada	30	7

Manifestações cutâneas	Referências	Achados histológicos em biópsia
Lesão tipo Chilblain	⁹9 Locatelli AG, Test E, Vezzoli P, Carugno A, Moggio E, Consonni L, et al. Histologic features of long-lasting chilblain-like lesions in a paediatric COVID-19 patient. J Eur Acad Dermatol Venereol. 2020;34:365-8. https://doi.org/10.1111/jdv.16617 https://doi.org/10.1111/jdv.16617...	Edema papilar da derme, infiltrado linfocítico perivascular e perieccrino.
	¹⁴14 Colonna C, Monzani NA, Rocchi A, Gianotti R, Boggio F, Gelmetti C. Chilblain-like lesions in children following suspected COVID-19 infection. Pediatr Dermatol. 2020;37:437-40. https://doi.org/10.1111/pde.14210 https://doi.org/10.1111/pde.14210...	Infiltrados linfocíticos perivasculares e periadnexais densos que se estendem até a região subcutânea.
	¹⁷17 García-Gil MF, García M, Serrano J, Prieto-Torres L, Ara-Martín M. Acral purpuric lesions (erythema multiforme type) associated with thrombotic vasculopathy in a child during the COVID-19 pandemic. J Eur Acad Dermatol Venereol. 2020;34:e443-5. https://doi.org/10.1111/jdv.16644 https://doi.org/10.1111/jdv.16644...	Necrose epidérmica parcial e infiltrado linfocítico perivascular na derme. Capilares na derme papilar com microtrombos e extravasamento de eritrócitos.
	¹⁸18 Roca-Ginés J, Torres-Navarro I, Sánchez-Arráez J, Abril-Pérez C, Sabalza-Baztán O, Pardo-Granell S, et al. Assessment of Acute Acral Lesions in a case series of children and adolescents during the COVID-19 pandemic. JAMA Dermatol. 2020;156:992-7. https://doi.org/10.1001/jamadermatol.2020.2340 https://doi.org/10.1001/jamadermatol.202...	Edema moderado na derme papilar, infiltrado perivascular, infiltrado de vasculite linfocítica. Perieccrino e infiltrado perivascular.
	¹⁹19 Colmenero I, Santonja C, Alonso-Riaño M, Noguera-Morel L, Hernández-Martín A, Andina D, et al. SARS-CoV-2 endothelial infection causes COVID-19 chilblains: histopathological, immunohistochemical and ultrastructural study of seven paediatric cases. Br J Dermatol. 2020;183:729-37. https://doi.org/10.1111/bjd.19327 https://doi.org/10.1111/bjd.19327...	Alterações vacuolares na camada basal, espongiose, edema dérmico, inflamação perivascular.
	²⁰20 López-Robles J, Hera I, Pardo-Sánchez J, Ruiz-Martínez J, Cutillas-Marco E. Chilblain-like lesions: a case series of 41 patients during the COVID-19 pandemic. Clin Exp Dermatol. 2020;45:891-2. https://doi.org/10.1111/ced.14275 https://doi.org/10.1111/ced.14275...	Degeneração vacuolar da camada basal com queratinócitos necróticos esparsos e infiltrado linfocítico perivascular, sem evidência de trombose.
	²¹21 Andina D, Noguera-Morel L, Bascuas-Arribas M, Gaitero-Tristán J, Alonso-Cadenas JA, Escalada-Pellitero S, et al. Chilblains in children in the setting of COVID-19 pandemic. Pediatr Dermatol. 2020;37:406-11. https://doi.org/10.1111/pde.14215 https://doi.org/10.1111/pde.14215...	Infiltrado de linfócitos perivascular e periadnexal, edema papilar dérmico, degeneração vacuolar da camada basal e exocitose linfocítica para a epiderme e através da siringe.
	²³23 Cordoro KM, Reynolds SD, Wattier R, McCalmont TH. Clustered cases of acral perniosis: clinical features, histopathology, and relationship to COVID-19. Pediatr Dermatol. 2020;37:419-23. https://doi.org/10.1111/pde.14227 https://doi.org/10.1111/pde.14227...	Infiltrado linfocítico perivascular e vasculite superficial e linfocítica, sem evidências de trombose.
	²⁴24 Schnapp A, Abulhija H, Maly A, Armoni-Weiss G, Levin Y, Faitatziadou SM, et al. Introductory histopathological findings may shed light on COVID-19 paediatric hyperinflammatory shock syndrome. J Eur Acad Dermatol Venereol. 2020;34:665-7. https://doi.org/10.1111/jdv.16749 https://doi.org/10.1111/jdv.16749...	Necrose epidérmica e dérmica extensa com trombos nos vasos. Infiltração neutrofílica e detritos nucleares ao redor dos vasos.
	⁸8 Mazzotta F, Troccoli T. Acute acro-ischemia in the child at the time of COVID-19. Eur J Pediat Dermatol. 2020;30:71-4. https://doi.org/10.26326/2281-9649.30.2.2102 https://doi.org/10.26326/2281-9649.30.2.... , ¹⁰10 Neri I, Patrizi A, Gabrielli L, Virdi A, Veronesi G, Corsini I, et al. Acral skin eruption observed during SARS-CoV-2 pandemic: possible keratolysis exfoliativa with red palms and soles. J Eur Acad Dermatol Venereol. 2020;34:783-5. https://doi.org/10.1111/jdv.16881 https://doi.org/10.1111/jdv.16881... –¹³13 Mastrolonardo M, Romita P, Bonifazi E, Giuffrida R, Lotti T, Foti C, et al. The management of the outbreak of acral skin manifestations in asymptomatic children during COVID-19 era. Dermatol Ther. 2020;33:13617. https://doi.org/10.1111/dth.13617 https://doi.org/10.1111/dth.13617... , ¹⁵15 Serrano JM, Monferrer JC, García-Gil MF. Acro-ischemic skin lesions during COVID-19 epidemic. Semergen. 2020;46:103-5. https://doi.org/10.1016/j.semerg.2020.05.003 https://doi.org/10.1016/j.semerg.2020.05... , ¹⁶16 Rosés-Gibert P, Castillo J, Aguirre A, Gomar FJ, González L, Arcaya Z, et al. Acral lesions in a pediatric population during the COVID-19 pandemic: a case series of 36 patients from a single hospital in Spain. World J Pediatr. 2020;16:629-32. https://doi.org/10.1007/s12519-020-00390-0 https://doi.org/10.1007/s12519-020-00390... , ²²22 Garcia-Lara G, Linares-González L, Ródenas-Herranz T, Ruiz-Villaverde R. Chilblain-like lesions in pediatrics dermatological outpatients during the COVID-19 outbreak. Dermatol Ther. 2020;33:13516. https://doi.org/10.1111/dth.13516 https://doi.org/10.1111/dth.13516... , ²⁵25 Rafai M, Elbenaye J, Sabry S, Janah H. Delayed hypersensitivity as a pathophysiological mechanism in cutaneous lesions due to SARS-CoV-2. Pan Afr Med J. 2020;35:115. https://doi.org/10.11604/pamj.supp.2020.35.2.24980 https://doi.org/10.11604/pamj.supp.2020....	Não realizada
Lesão tipo eritema multiforme	²⁷27 El Hachem M, Diociaiuti A, Concato C, Carsetti R, Carnevale C, Atti M, et al. A clinical, histopathological and laboratory study of 19 consecutive Italian paediatric patients with chilblain-like lesions: lights and shadows on the relationship with COVID-19 infection. J Eur Acad Dermatol Venereol. 2020;34:2620-9. https://doi.org/10.1111/jdv.16682 https://doi.org/10.1111/jdv.16682...	Edema papilar da derme e extravasamento de eritrócitos. Infiltrado linfocítico perivascular.
	³⁰30 Torrelo A, Andina D, Santonja C, Noguera-Morel L, Bascuas-Arribas M, Gaitero-Tristán J, et al. Erythema multiforme-like lesions in children and COVID-19. Pediatr Dermatol. 2020;37:442-6. https://doi.org/10.1111/pde.14246 https://doi.org/10.1111/pde.14246...	Espongiose e exocitose de linfócitos. Infiltrado linfocítico perivascular sem eosinófilos ou queratinócitos necróticos. Ectasia vascular e vasculite linfocítica. Necrose fibrinóide e trombose estavam ausentes.
	²²22 Garcia-Lara G, Linares-González L, Ródenas-Herranz T, Ruiz-Villaverde R. Chilblain-like lesions in pediatrics dermatological outpatients during the COVID-19 outbreak. Dermatol Ther. 2020;33:13516. https://doi.org/10.1111/dth.13516 https://doi.org/10.1111/dth.13516... , ²⁶26 Maniaci A, Iannella G, Vicini C, Pavone P, Nunnari G, Falsaperla R, et al. A Case of COVID-19 with late-onset rash and transient loss of taste and smell in a 15-year-old boy. Am J Case Rep. 2020;21:925813. https://doi.org/10.12659/AJCR.925813 https://doi.org/10.12659/AJCR.925813... , ²⁸28 Piccolo V, Neri I, Filippeschi C, Oranges T, Argenziano G, Battarra VC, et al. Chilblain-like lesions during COVID-19 epidemic: a preliminary study on 63 patients. J Eur Acad Dermatol Venereol. 2020;34:291-3. https://doi.org/10.1111/jdv.16526 https://doi.org/10.1111/jdv.16526... , ²⁹29 Morey-Olivé M, Espiau M, Mercadal-Hally M, Lera-Carballo E, García-Patos V. Manifestaciones cutáneas en contexto del brote actual de enfermedad por coronavirus 2019. An Pediatr (Barc). 2020;92:377-8. https://doi.org/10.1016/j.anpedi.2020.04.013 https://doi.org/10.1016/j.anpedi.2020.04... , ³¹31 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 (Engl Ed). 2020;92:374-5. https://doi.org/10.1016/j.anpede.2020.04.002 https://doi.org/10.1016/j.anpede.2020.04... –³⁹39 Olisova OY, Anpilogova EM, Shnakhova LM. Cutaneous manifestations in COVID-19: a skin rash in a child. Dermatol Ther. 2020;33:13712. https://doi.org/10.1111/dth.13712 https://doi.org/10.1111/dth.13712...	Não realizada
Lesão tipo varicela	⁴⁰40 Genovese G, Colonna C, Marzano AV. Varicella-like exanthem associated with COVID-19 in an 8-year-old girl: a diagnostic clue? Pediatr Dermatol. 2020;37:435-6. https://doi.org/10.1111/pde.14201 https://doi.org/10.1111/pde.14201... –⁴²42 Aghazadeh N, Homayouni M, Sartori-Valinotti JC. Oral vesicles and acral erythema: report of a cutaneous manifestation of COVID-19. Int J Dermatol. 2020;59:1153-4. https://doi.org/10.1111/ijd.15047 https://doi.org/10.1111/ijd.15047...	Não realizada

Desenho do estudo	Referências	Classificação de qualidade
Relatos de caso	⁸8 Mazzotta F, Troccoli T. Acute acro-ischemia in the child at the time of COVID-19. Eur J Pediat Dermatol. 2020;30:71-4. https://doi.org/10.26326/2281-9649.30.2.2102 https://doi.org/10.26326/2281-9649.30.2.... , ⁹9 Locatelli AG, Test E, Vezzoli P, Carugno A, Moggio E, Consonni L, et al. Histologic features of long-lasting chilblain-like lesions in a paediatric COVID-19 patient. J Eur Acad Dermatol Venereol. 2020;34:365-8. https://doi.org/10.1111/jdv.16617 https://doi.org/10.1111/jdv.16617... , ¹⁴14 Colonna C, Monzani NA, Rocchi A, Gianotti R, Boggio F, Gelmetti C. Chilblain-like lesions in children following suspected COVID-19 infection. Pediatr Dermatol. 2020;37:437-40. https://doi.org/10.1111/pde.14210 https://doi.org/10.1111/pde.14210... , ²⁵25 Rafai M, Elbenaye J, Sabry S, Janah H. Delayed hypersensitivity as a pathophysiological mechanism in cutaneous lesions due to SARS-CoV-2. Pan Afr Med J. 2020;35:115. https://doi.org/10.11604/pamj.supp.2020.35.2.24980 https://doi.org/10.11604/pamj.supp.2020.... , ²⁹29 Morey-Olivé M, Espiau M, Mercadal-Hally M, Lera-Carballo E, García-Patos V. Manifestaciones cutáneas en contexto del brote actual de enfermedad por coronavirus 2019. An Pediatr (Barc). 2020;92:377-8. https://doi.org/10.1016/j.anpedi.2020.04.013 https://doi.org/10.1016/j.anpedi.2020.04... , ³¹31 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 (Engl Ed). 2020;92:374-5. https://doi.org/10.1016/j.anpede.2020.04.002 https://doi.org/10.1016/j.anpede.2020.04... , ³³33 Wolfe DM, Nassar GN, Divya K, Krilov LR, Noor A. Young children presenting with fever and rash in the midst of SARS-CoV-2 outbreak in New York. Clin Pediatr (Phila). 2020;59:1112-8. https://doi.org/10.1177/0009922820941631 https://doi.org/10.1177/0009922820941631... , ³⁶36 Ng SM. Prolonged dermatological manifestation 4 weeks following recovery of COVID-19 in a child. BMJ Case Rep. 2020;13:237056. https://doi.org/10.1136/bcr-2020-237056 https://doi.org/10.1136/bcr-2020-237056... –⁴⁰40 Genovese G, Colonna C, Marzano AV. Varicella-like exanthem associated with COVID-19 in an 8-year-old girl: a diagnostic clue? Pediatr Dermatol. 2020;37:435-6. https://doi.org/10.1111/pde.14201 https://doi.org/10.1111/pde.14201... , ⁴²42 Aghazadeh N, Homayouni M, Sartori-Valinotti JC. Oral vesicles and acral erythema: report of a cutaneous manifestation of COVID-19. Int J Dermatol. 2020;59:1153-4. https://doi.org/10.1111/ijd.15047 https://doi.org/10.1111/ijd.15047...	Bom
	¹⁷17 García-Gil MF, García M, Serrano J, Prieto-Torres L, Ara-Martín M. Acral purpuric lesions (erythema multiforme type) associated with thrombotic vasculopathy in a child during the COVID-19 pandemic. J Eur Acad Dermatol Venereol. 2020;34:e443-5. https://doi.org/10.1111/jdv.16644 https://doi.org/10.1111/jdv.16644... , ²⁴24 Schnapp A, Abulhija H, Maly A, Armoni-Weiss G, Levin Y, Faitatziadou SM, et al. Introductory histopathological findings may shed light on COVID-19 paediatric hyperinflammatory shock syndrome. J Eur Acad Dermatol Venereol. 2020;34:665-7. https://doi.org/10.1111/jdv.16749 https://doi.org/10.1111/jdv.16749... , ²⁶26 Maniaci A, Iannella G, Vicini C, Pavone P, Nunnari G, Falsaperla R, et al. A Case of COVID-19 with late-onset rash and transient loss of taste and smell in a 15-year-old boy. Am J Case Rep. 2020;21:925813. https://doi.org/10.12659/AJCR.925813 https://doi.org/10.12659/AJCR.925813... , ³²32 Patek P, Corcoran J, Adams L, Khandhar P. SARS-CoV-2 infection in a 2-week-old male with neutropenia. Clin Pediatr (Phila). 2020;59:918-20. https://doi.org/10.1177/0009922820920014 https://doi.org/10.1177/0009922820920014... , ³⁵35 Yozgat CY, Uzuner S, Duramaz B, Yozgat Y, Erenberk U, Iscan A, et al. Dermatological manifestation of pediatrics multisystem inflammatory syndrome associated with COVID-19 in a 3-year-old girl. Dermatol Ther. 2020;33:13770. https://doi.org/10.1111/dth.13770 https://doi.org/10.1111/dth.13770...	Regular
	¹⁵15 Serrano JM, Monferrer JC, García-Gil MF. Acro-ischemic skin lesions during COVID-19 epidemic. Semergen. 2020;46:103-5. https://doi.org/10.1016/j.semerg.2020.05.003 https://doi.org/10.1016/j.semerg.2020.05...	Ruim
Série de casos	¹⁹19 Colmenero I, Santonja C, Alonso-Riaño M, Noguera-Morel L, Hernández-Martín A, Andina D, et al. SARS-CoV-2 endothelial infection causes COVID-19 chilblains: histopathological, immunohistochemical and ultrastructural study of seven paediatric cases. Br J Dermatol. 2020;183:729-37. https://doi.org/10.1111/bjd.19327 https://doi.org/10.1111/bjd.19327... , ²³23 Cordoro KM, Reynolds SD, Wattier R, McCalmont TH. Clustered cases of acral perniosis: clinical features, histopathology, and relationship to COVID-19. Pediatr Dermatol. 2020;37:419-23. https://doi.org/10.1111/pde.14227 https://doi.org/10.1111/pde.14227... , ³⁰30 Torrelo A, Andina D, Santonja C, Noguera-Morel L, Bascuas-Arribas M, Gaitero-Tristán J, et al. Erythema multiforme-like lesions in children and COVID-19. Pediatr Dermatol. 2020;37:442-6. https://doi.org/10.1111/pde.14246 https://doi.org/10.1111/pde.14246... , ⁴¹41 Marzano AV, Genovese G, Fabbrocini G, Pigatto P, Monfrecola G, Piraccini BM, et al. Varicella-like exanthem as a specific COVID-19-associated skin manifestation: Multicenter case series of 22 patients. J Am Acad Dermatol. 2020;83:280-5. https://doi.org/10.1016/j.jaad.2020.04.044 https://doi.org/10.1016/j.jaad.2020.04.0...	Bom
	¹⁶16 Rosés-Gibert P, Castillo J, Aguirre A, Gomar FJ, González L, Arcaya Z, et al. Acral lesions in a pediatric population during the COVID-19 pandemic: a case series of 36 patients from a single hospital in Spain. World J Pediatr. 2020;16:629-32. https://doi.org/10.1007/s12519-020-00390-0 https://doi.org/10.1007/s12519-020-00390... , ¹⁸18 Roca-Ginés J, Torres-Navarro I, Sánchez-Arráez J, Abril-Pérez C, Sabalza-Baztán O, Pardo-Granell S, et al. Assessment of Acute Acral Lesions in a case series of children and adolescents during the COVID-19 pandemic. JAMA Dermatol. 2020;156:992-7. https://doi.org/10.1001/jamadermatol.2020.2340 https://doi.org/10.1001/jamadermatol.202... , ²⁰20 López-Robles J, Hera I, Pardo-Sánchez J, Ruiz-Martínez J, Cutillas-Marco E. Chilblain-like lesions: a case series of 41 patients during the COVID-19 pandemic. Clin Exp Dermatol. 2020;45:891-2. https://doi.org/10.1111/ced.14275 https://doi.org/10.1111/ced.14275...	Regular
	¹⁰10 Neri I, Patrizi A, Gabrielli L, Virdi A, Veronesi G, Corsini I, et al. Acral skin eruption observed during SARS-CoV-2 pandemic: possible keratolysis exfoliativa with red palms and soles. J Eur Acad Dermatol Venereol. 2020;34:783-5. https://doi.org/10.1111/jdv.16881 https://doi.org/10.1111/jdv.16881...	Ruim
Coortes	²¹21 Andina D, Noguera-Morel L, Bascuas-Arribas M, Gaitero-Tristán J, Alonso-Cadenas JA, Escalada-Pellitero S, et al. Chilblains in children in the setting of COVID-19 pandemic. Pediatr Dermatol. 2020;37:406-11. https://doi.org/10.1111/pde.14215 https://doi.org/10.1111/pde.14215... , ²²22 Garcia-Lara G, Linares-González L, Ródenas-Herranz T, Ruiz-Villaverde R. Chilblain-like lesions in pediatrics dermatological outpatients during the COVID-19 outbreak. Dermatol Ther. 2020;33:13516. https://doi.org/10.1111/dth.13516 https://doi.org/10.1111/dth.13516... , ²⁸28 Piccolo V, Neri I, Filippeschi C, Oranges T, Argenziano G, Battarra VC, et al. Chilblain-like lesions during COVID-19 epidemic: a preliminary study on 63 patients. J Eur Acad Dermatol Venereol. 2020;34:291-3. https://doi.org/10.1111/jdv.16526 https://doi.org/10.1111/jdv.16526...	Bom
Coortes	³⁴34 Pouletty M, Borocco C, Ouldali N, Caseris M, Basmaci R, Lachaume N, et al. Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 mimicking Kawasaki disease (Kawa-COVID-19): a multicentre cohort. Ann Rheum Dis. 2020;79:999-1006. https://doi.org/10.1136/annrheumdis-2020-217960 https://doi.org/10.1136/annrheumdis-2020...	Ruim
Transversal	¹¹11 Diociaiuti A, Giancristoforo S, Terreri S, Corbeddu M, Concato C, Degli Atti M, et al. Are SARS-CoV-2 IgA antibodies in paediatric patients with chilblain-like lesions indicative of COVID-19 asymptomatic or paucisymptomatic infection? J Eur Acad Dermatol Venereol. 2021;35:e10-3. https://doi.org/10.1111/jdv.16934 https://doi.org/10.1111/jdv.16934... , ¹²12 Gallizzi R, Sutera D, Spagnolo A, Bagnato AM, Cannavò SP, Grasso L, et al. Management of pernio-like cutaneous manifestations in children during the outbreak of COVID-19. Dermatol Ther. 2020;33:14312. https://doi.org/10.1111/dth.14312 https://doi.org/10.1111/dth.14312...	Bom
Transversal	¹³13 Mastrolonardo M, Romita P, Bonifazi E, Giuffrida R, Lotti T, Foti C, et al. The management of the outbreak of acral skin manifestations in asymptomatic children during COVID-19 era. Dermatol Ther. 2020;33:13617. https://doi.org/10.1111/dth.13617 https://doi.org/10.1111/dth.13617...	Regular
Controle de caso	²⁷27 El Hachem M, Diociaiuti A, Concato C, Carsetti R, Carnevale C, Atti M, et al. A clinical, histopathological and laboratory study of 19 consecutive Italian paediatric patients with chilblain-like lesions: lights and shadows on the relationship with COVID-19 infection. J Eur Acad Dermatol Venereol. 2020;34:2620-9. https://doi.org/10.1111/jdv.16682 https://doi.org/10.1111/jdv.16682...	Regular

Manifestações cutâneas da COVID-19	Porcentagem de casos reportados	Local da lesão	Tempo médio até a manifestação da lesão (dias)	Duração média da lesão (dias)	Idade média dos pacientes (anos)	Sexo do paciente
Lesão tipo Chilblain	67,5%	100% Extremidades	7,6 (IC 95% 7,4–7,8)	17,5 (IC 95% 16,5–18,5)	13 (IC 95% 12,9–13,1)	37% Mulheres 63% Homens
Lesão tipo eritema multiforme	31,7%	83% Extremidades 17% Generalizadas	9,5 (IC 95% 9–10)	10,3 (IC 95% 9,1–11,5)	12,5 (IC 95% 12,3–12,7)	44% Mulheres 56% Homens
Lesão tipo varicela	0,8%	100% Generalizadas	12,3 (IC 95% 4–20,6)	7	8,5 (IC 95% 8–9)	67% Mulheres 33% Homens

[1] *Autor correspondente. E-mail: pasquinirpf@terra.com.br (R. Pasquini Neto).

Brasil

Brasil

Manifestações cutâneas da COVID-19 em crianças e adolescentes: uma revisão sistemática

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