OBJECTIVE: In spring 2020, high numbers of children presented with acral pernio-like skin rashes, concurrent with the coronavirus disease 2019 (COVID-19) pandemic . Understanding their clinical characteristics/ infection status may provide prognostic information and facilitate decisions about management .
METHODS: A pediatric-specific dermatology registry was created by the Pediatric Dermatology COVID-19 Response Task Force of the Society for Pediatric Dermatology (SPD) and Pediatric Dermatology Research Alliance (PeDRA) and was managed by Children's Hospital of Philadelphia using REDCap .
RESULTS: Data from 378 children 0-18 years entered into the registry between April 13 and July 17, 2020 were analyzed . Data were drawn from a standardized questionnaire completed by clinicians which asked for demographics, description of acral lesions, symptoms before and after acral changes, COVID-19 positive contacts, treatment, duration of skin changes, laboratory testing including SARS-CoV-2 PCR and antibody testing, as well as histopathology . 229 (60.6 %) were male with mean age of 13.0 years (± 3.6 years). Six (1.6 %) tested positive for SARS-CoV-2 . Pedal lesions (often with pruritus and/or pain) were present in 96% . 30% (114/378) had COVID-19 symptoms during the 30 days prior to presentation . Most (69 %) had no other symptoms and an uneventful course with complete recovery .
CONCLUSIONS AND RELEVANCE: Children with acral pernio-like changes were healthy and all recovered with no short-term sequelae . We believe these acral changes are not just a temporal epiphenomenon of shelter in place during the spring months of the first wave of the COVID-19 pandemic and may be a late phase reaction that needs further study.
Index: exanthems, infection-viral, skin signs of systemic disease