COVID-19 Associated Rashes in Children

As the pandemic continues to spread across our nation and the world, many people are learning that there are skin manifestations of COVID-19, caused by the novel coronavirus SARS-CoV-2.

Children are often asymptomatic while infected, but may have cutaneous manifestations of COVID-19. These include rashes on the trunk and extremities, lesions of toes with purple discoloration and ulcers, widespread bruising or pinpoint bruising.

Patients have also developed hive-like lesions (urticarial) or tiny red bumps and flat spots that are widespread and nonspecific, usually on the trunk or arms and legs. These may be more common in more severe cases and older patients.

“Covid toes,” or chilblains-like lesions (pernio), consist of purple to dark red colored toes (or sometimes fingers), often with swelling. These have been reported in pediatric patients with coronavirus infection. Children’s fingers may also show ulceration, drainage of pus, or peeling of the ends of the toes or fingers. Usually, these lesions are asymptomatic, but patients should be watched for other symptoms of COVID-19 including fever, cough, shortness of breath, loss of smell or taste, diarrhea. If other symptoms occur, call your child’s pediatrician.

Rarely children who recover from COVID-19 go on to develop a condition known as multisystem inflammatory syndrome in children (MIS-C). This may be attributed to the child’s immune system overreacting to the viral infection. Symptoms include the following: rash, bloodshot eyes, discolored and cracked lips, swollen/discolored hands or feet, swollen tongue that looks like a strawberry. MIS-C can also cause other signs and symptoms, including:

• Fever that lasts for days
• Abdominal pain (a tummy ache)
• Vomiting
• Diarrhea
• Swollen gland in neck
• Confusion
• Trouble staying awake

If your child has any of these signs or symptoms, call your child’s doctor right away. Most children who have MIS-C get better with medical care.