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Cutaneous Findings Described for Children With MIS-C

FRIDAY, Feb. 26, 2021 -- In a research letter published online Feb. 16 in Open Forum Infectious Diseases, cutaneous findings are described for multisystem inflammatory syndrome in children (MIS-C) associated with prior SARS-CoV-2 infection.

Allison M. Blatz, M.D., from the Children's Hospital of Philadelphia, and colleagues describe cutaneous findings in a series of children with MIS-C-associated rash at a single institution. Twenty-four children were diagnosed with MIS-C as of July 28, 2020, of whom 75 percent exhibited mucocutaneous changes; consent was obtained for seven of the patients.

The researchers found that three of the patients had palmar and plantar erythema; no patients exhibited plantar erythema without palmar erythema. Discrete lesions were seen in all body locations, with lesions on the chest and upper extremities common (four patients) and the lower extremities uniformly involved. Five patients had lesions on the proximal medial thigh. Mucosal changes were common (six patients) and included lip changes, but the remaining face was involved less frequently. The most common lesions were small-to-medium annular plaques in four patients; morbilliform eruptions with coalescing papules to plaques and coalescing macules were also noted, each in one patient. In two patients, the investigators noted reticulated plaques and patches. Two patients described the rash as mildly pruritic. Purpura were seen in four patients. By the time of hospital discharge, all skin findings were completely resolved.

"Depending on the age of the child, parents may not regularly look at the child's chest, back or thighs, but this is where the rashes associated with MIS-C tend to appear," a coauthor said in a statement. "Given that MIS-C is still largely a diagnosis of exclusion, parents and health care providers should look for rashes in these locations if the child has a fever that seems suspicious."

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