Skin Manifestations Associated with COVID-19: Current Knowledge and Future Perspectives.

BACKGROUND: Coronavirus disease-19 (COVID-19) is an ongoing global pandemic caused by the "severe acute respiratory syndrome coronavirus 2" (SARS-CoV-2), which was isolated for the first time in Wuhan (China) in December 2019. Common symptoms include fever, cough, fatigue, dyspnea and hypogeusia/hyposmia. Among extrapulmonary signs associated with COVID-19, dermatological manifestations have been increasingly reported in the last few months. SUMMARY: The polymorphic nature of COVID-19-associated cutaneous manifestations led our group to propose a classification, which distinguishes the following six main clinical patterns: (i) urticarial rash, (ii) confluent erythematous/maculopapular/morbilliform rash, (iii) papulovesicular exanthem, (iv) chilblain-like acral pattern, (v) livedo reticularis/racemosa-like pattern, (vi) purpuric "vasculitic" pattern. This review summarizes the current knowledge on COVID-19-associated cutaneous manifestations, focusing on clinical features and therapeutic management of each category and attempting to give an overview of the hypothesized pathophysiological mechanisms of these conditions.

Gianotti-Crosti syndrome (papular acrodermatitis of childhood) in the era of a viral recrudescence and vaccine opposition.

BACKGROUND: Gianotti-Crosti syndrome is characterized by an acute onset of a papular or papulovesicular eruption with a symmetrical distribution. DATA SOURCES: A PubMed search was conducted using Clinical Queries with the key terms "Gianotti-Crosti syndrome" OR "papular acrodermatitis". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. This paper is based on, but not limited to, the search results. RESULTS: The eruption of Gianotti-Crosti syndrome is found predominantly on the cheeks, extensor surfaces of the extremities, and buttocks. There is a sparing of antecubital and popliteal fossae as well as palms, soles, and mucosal surfaces. Although often asymptomatic, the lesions may be mildly to moderately pruritic. Gianotti-Crosti syndrome is most common in children between 1 and 6 years of age. The Epstein-Barr virus and the hepatitis B virus are the most common pathogens associated with Gianotti-Crosti syndrome. No treatment for Gianotti-Crosti syndrome is necessary because it is self-limited. In an era of vaccine hesitancy and refusal, Gianotti-Crosti syndrome may be important to mention to parents, because it can occur and trigger alarmism. CONCLUSIONS: Gianotti-Crosti syndrome is mainly a disease of early childhood, characterized by an acute onset of a papular or papulovesicular eruption with a symmetrical distribution. With the advent of more universal vaccination against hepatitis B virus, Epstein-Barr virus has become the most common etiologic agent of Gianotti-Crosti syndrome. Few cases of post-vaccination Gianotti-Crosti syndrome have been reported. Currently, the emphasis should be placed on its self-limiting attribution.

Atypical Gianotti-Crosti syndrome.

We report the case of a male 22-month-old child, with atypical presentation of Gianotti-Crosti syndrome after infection with Epstein-Barr virus.

Atypical Gianotti-Crosti syndrome

Abstract: We report the case of a male 22-month-old child, with atypical presentation of Gianotti-Crosti syndrome after infection with Epstein-Barr virus.

Paraviral exanthems.

INTRODUCTION: Paraviral exanthems are skin diseases suspected to be caused by viruses, with a single virus-exanthem relationship not universally accepted. Although most paraviral exanthems are self-remitting, accurate diagnoses are important as some patients might develop complications. Some of the differential diagnoses might cause serious complications, and some paraviral exanthems might lead to complications for at-risk groups such as pregnant women. Moreover, some paraviral exanthems might be symptomatic such as the development of severe pruritus, with relief of such being crucial in the plan of management. Patients and carers of patients should also be counselled regarding the aetiologies, clinical features, and prognoses of the exanthems concerned. AREAS COVERED: We covered the clinical manifestations and managements of pityriasis rosea, pityriasis lichenoides, and Gianotti-Crosti syndrome. Expert Commentary: Most patients with pityriasis rosea do not need any active intervention. Symptomatic relief of the pruritus would be adequate. For patients with pityriasis rosea that are serious, extensive, or causing severe impacts of their quality of life, oral acyclovir could be considered. For pityriasis lichenoides, managements would be depending on the type of the exanthem such as the acute form (pityriasis lichenoides et varioliformis acuta, also known as Mucha Habermann disease) the chronic form (pityriasis lichenoides chronic Juliusberg's disease), and the febrile ulceronecrotic Mucha-Habermann disease, which is a complication of the acute form. The management of Gianotti-Crosti syndrome is mainly symptomatic. The need for long-term follow-up for chronic complications of the underlying viral infections is still controversial.

Cutaneous infectious diseases: Kids are not just little people.

The changes in immune response that occur with age play a significant role in disease presentation and patient management. Evolution of the innate and adaptive immune systems throughout life, influenced partly by hormonal changes associated with puberty, plays a role in the differences between pediatric and adult response to disease. We review a series of manifestations of dermatologic infectious diseases spanning bacterial, viral, and fungal origins that can be seen in both pediatric and adult age groups and highlight similarities and differences in presentation and disease course. Therapeutic options are also discussed for these infectious diseases, with particular attention to variations in management between these population subgroups, given differences in pharmacokinetics and side effect profiles.

[Skin disorder as an indication of viral infection]. / Huidafwijking als aanwijzing voor virusinfectie.

BACKGROUND: Gianotti-Crosti syndrome (GCS) is a dermatosis primarily affecting children between 2 and 6 years of age. It is characterized by multiple, itching, monomorphous, pink to red-brown papules or papulovesicles between 1 and 5 mm in size. GCS is associated with viral infections such as hepatitis B virus and Epstein-Barr virus (EBV). It is often accompanied by fever, hepatosplenomegaly and lymphadenopathy. The syndrome is self-limiting and disappears within 2 months. No treatment is therefore required. CASE DESCRIPTION: We report a case of a 16-year-old female who presented with itching papulovesicles on the extremities and on the buttocks. She was diagnosed with GCS because of the clinical findings, histopathological tests and positive EBV serology. CONCLUSION: GCS can also affect patients older than 6 years of age. Moreover, this syndrome may be a first sign of infection with Epstein-Barr virus, hepatitis B virus, HIV or other viral infections.

Epstein-Barr virus and skin manifestations in childhood.

Epstein-Barr virus (EBV) is a human B-lymphotropic herpes virus and one of the most common viruses in humans. Specific skin signs related to EBV infection are the exanthem of mononucleosis, which is observed more frequently after ingestion of amoxicillin, and oral hairy leukoplakia, a disease occurring mostly in immunocompromised subjects with HIV infection. Other more uncommon cutaneous disorders that have been associated with EBV infection include virus-related exanthems or diseases such as Gianotti-Crosti syndrome, erythema multiforme, and acute genital ulcers. Other skin manifestations, not correlated to virus infection, such as hydroa vacciniforme and drug-induced hypersensitivity syndrome have also been linked to EBV. The putative involvement of EBV in skin diseases is growing similarly to other areas of medicine, where the role of EBV infection is being investigated in potentially debilitating inflammatory diseases. The prognosis of EBV infection in healthy, immunocompetent individuals is excellent. However, lifelong infection, which is kept in check by the host immune system, determines an unpredictable risk of pathologic unpredictable scenarios. In this review, we describe the spectrum of non-tumoral dermatological manifestations that can follow EBV primary infection or reactivation of EBV in childhood.

Papular-purpuric gloves and socks syndrome due to parvovirus B19: a report of two simultaneous cases in cohabitant families.

The so-called papular-purpuric gloves and socks syndrome (PPGSS) is a condition characterized by acute onset of intense erythema, edema and petechiae with a typical localization on the hands and feet, besides mucosal lesions of the oral cavity. The syndrome has a favorable and self-limited course, requiring only a symptomatic therapy. In the 50% of the cases described in literature (ninety cases in 22 years), is documented an acute infection caused by parvovirus B19 and in only two cases the onset of PPGSS is reported among different members of the same family. The aim of the work is to describe two cases of PPGSS arisen during a short time period in two family members affected by an acute parvovirus B19 infection found by serum sampling. The peculiarity of the study was the infrequence of the syndrome and the rareness of the description of PPGSS in rheumatology. This syndrome is usually described in dermatology, but it is also interesting for the rheumatologist because it comes in differential diagnosis with various autoimmune diseases.

Papular-purpuric "gloves and socks" syndrome.

Papular-purpuric "gloves and socks" syndrome (PPGSS), is an acute dermatosis characterized by a papular-purpuric edematous rash in a distinct ''gloves and socks'' distribution often accompanied by fever, asthenia and lymphadenophaties. It is mainly caused by parvovirus B19 (B19V) but other viruses and drugs such as trimethoprim/sulfametaxol or chemotherapics may be involved. We describe a case of PPGSS with a serologically proven B19V infection in a 42-year-old Italian kindergarten teacher suffering from acute bacterial pharyngitis Immunoglobulin M by enzyme-linked immunosorbent assay (ELISA) to parvovirus B19 were positive. Histological examination showed dermal-ipodermal inflammation with evidence of leukocytoclastic vasculitis principally interesting the small venules The cutaneous rash resolved after 2 weeks. We reported our case to support that PPGSS is an immunomediated disease and that B19V morbidity varies with the immunologic and hematologic status of the host. In addition, a patient with PPGSS might be infectious at the moment of diagnosis, with significant implication for susceptible contacts.

Gianotti-Crosti syndrome after H1N1-influenza vaccine.

Papular acrodermatitis of childhood, or Gianotti-Crosti syndrome, is a symmetric papular or papulovesicular acral exanthem associated with several infectious agents and immunizations. We present a case of Gianotti-Crosti syndrome appearing shortly after H1N1-influenza vaccination. This has not been previously reported to our knowledge.

Giannoti-Crosti syndrome associated with type A influenza.

Gianotti-Crosti syndrome is an entity characterized by an acute papular eruption in children and has been associated with a multitude of viruses. This is the first case reported in association with type A influenza, a virus that usually has no dermatologic findings.