Background: Although epidemic, novel coronavirus (SARS-CoV-2) infection rarely affects
the pediatric population. However, in the last months, an increasing number of Italian pediatricians
have reported the occurrence of erythema pernio-like in children following a flu-like syndrome,
after the outbreak of SARS-CoV-2 infection.
Objective: The study aims 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 SARSCoV-
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 the pediatric and adolescent population, the occurrence of an erythema pernio-like
after a flu-like syndrome could be associated with SARS-CoV-2 infection.