Erythema Pernio-like in four Adolescents in the era of the Coronavirus-2 Infection

Background Although epidemic, novel coronavirus (SARS-CoV-2) infection rarely affects pediatric population. However, in the last months an increasing number of Italian pediatricians has reported the occurrence of erythema pernio-like in children following a flu-like syndrome, after the outbreak of SARS-CoV-2 infection. Objective To report cutaneous manifestation of SARS-CoV-2 infection in 4 adolescents. Methods Observational study reporting 4 adolescents with skin lesions, 2 weeks after the occurrence of a flu-like syndrome. Results Fourteen days after a flu-like syndrome, adolescents exhibited skin lesions to toes and feet. These lesions were rounded, with blurred limits, with a 5-15 mm diameter, red-violaceous-bluish colored, sometimes resulting in bullous lesions in correspondence of the central or apical portion, which tended to be covered with blackish crusts after evolution. Lesions were also accompanied by pain of variable intensity and evolved within two or three weeks to self-resolution without particular sequelae. In two patients, pharyngeal and nasal swabs were negative for SARS-CoV-2 infection, at the presentation of skin lesions. After 2 months from clinical manifestations, patients were tested positive for SARS-CoV-2 antibodies. Conclusions In pediatric and adolescent population, the occurrence of an erythema pernio-like after a flu-like syndrome could be associated to SARS-CoV-2 infection.