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Scientists reveal the types of skin breakouts parents should look out for in MIS-C

Doctors have revealed the most common locations and types of skin rash found in children with a rare coronavirus-related hyperinflammation condition.

Named MIS-C, patients were first diagnosed in 2020 after doctors noticed some children developed inflammation in a range of organs after exposure to SARS-CoV-2, with the Centre for Disease Control saying it can be fatal, but most children survive. 

Experts from the Children’s Hospital of Philadelphia say diagnosing MIS-C has proved difficult as many of its symptoms, including rash, fever and gastrointestinal distress, are similar to other childhood conditions. 

The team found that while there was no single location for rashes to appear – they commonly occurred on the lower limbs, inner thigh, chest and upper extremities. 

In more than half of the seven patients examined, they usually presented as small to medium circles the size of a 5p coin with tiny red spots in the centre. 

Authors hope that by highlighting common coronavirus rashes in children, their findings may help doctors and parents know when a rash needs further study.

Small 5p sized plaques appear on the back of a child with MIS-C with tiny red spots inside

There was no single place where the rashes appeared, and no single style for the rash - but researchers found they were common on arms and legs

There was no single place where the rashes appeared, and no single style for the rash – but researchers found they were common on arms and legs

COMMON RASH LOCATIONS AND TYPES IN MIS-C 

Researchers found that while there was no single location for rashes in children with MIS-C, there were some common placements and types.

A study of seven children with the condition helped researchers spot some common trends.

All patients developed a rash on their lower body, and five had a rash on their inner thighs, the team found.

Rashes on the chest and upper extremities were also common, occurring in four out of seven patients.

More than half had small-to-medium annular plaques – circles the size of a UK 5p on the chest and back. 

More than half developed purpura – tiny red spots, often in the centre of the small circular annular plaques.

While some did develop a cherry-red rash on the bottoms of their feet and palms, this sort of rash was seen in less than half of the patients.

Rashes on the face were uncommon, and the rashes rarely itched.

In April 2020, doctors began recognising a syndrome in children involving hyperinflammation that results in an array of symptoms.

These symptoms included the usual Covid-19 issues including fever, but also added gastrointestinal distress and a rash. 

The syndrome, thought to be a post-infectious complication of Covid-19, was given the name Multisystem Inflammatory Syndrome Children, or MIS-C. 

However, diagnosing the condition has posed challenges, as many of its symptoms, including rash, are common in many other childhood infections. 

Philadelphia researchers say there also wasn’t a single type of rash, or rash placement common among all cases of MISH-C in the children they examined.

In a study published in Open Forum Infectious Diseases, researchers at Children’s Hospital of Philadelphia (CHOP) describe the array of rashes seen in MIS-C patients.

They say these are all seen within children with the condition and could hope the photos they share in the paper could help doctors diagnose future cases.  

‘We hope the information provided in this research letter will help general paediatricians and emergency department physicians who may wonder if a patient with a fever requires a more extensive examination,’ said author Audrey Odom John.

‘Given that some rashes associated with MIS-C are distinctive, we also imagine these images could help many parents who are looking for signs that their child needs prompt evaluation,’ the infectious disease expert from CHOP explained. 

All of the patients showed some degree of rash on their lower limbs, according to the team

All of the patients showed some degree of rash on their lower limbs, according to the team

One patient had a rash along the hairline - this was uncommon, with lower and upper limbs most common locations for a rash

One patient had a rash along the hairline – this was uncommon, with lower and upper limbs most common locations for a rash

A patient saw a rash develop on the neck (left) and another saw a much larger rash on their shoulder (right) but both were uncommon and not found in all children

A patient saw a rash develop on the neck (left) and another saw a much larger rash on their shoulder (right) but both were uncommon and not found in all children

In terms of rash location, all patients in the study developed a rash on their lower body, and five of the seven patients had a rash on their inner thighs. 

Rashes on the chest and upper extremities were also common, occurring in four out of seven patients, according to the doctors. 

More than half of the patients presented with small-to-medium annular plaques – circles the size of a UK 5p or US dime on the chest and back. 

More than half of the patients in the study also developed purpura – tiny red spots, often in the centre of the small circular annular plaques mentioned above.

The most common type of rash was a selection of small circles the size of a 5p on the back or stomach

The most common location for a rash was the lower limbs

Researchers found a number of locations for the rash, including the stomach and legs

No two rashes were identical, with some showing as multiple tiny dots and others as a few larger dots littered across the stomach, bag, legs and arms

No two rashes were identical, with some showing as multiple tiny dots and others as a few larger dots littered across the stomach, bag, legs and arms

While some patients did develop a cherry-red rash on the bottoms of their feet and palms of their hands, this sort of rash was seen in less than half of the patients.

Rashes on the face were uncommon, and the rashes rarely itched.

‘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,’ said John. 

‘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.’

The findings have been published in the journal Open Forum Infectious Diseases. 

MISC-C (Multisystem Inflammatory Syndrome Children) is a rare condition related to SARS-CoV-2

In April 2020 doctors started noticing a condition among some children with Coronavirus that resulted in a rash at various points on their body. 

It involved hyperinflammation that resulted in an array of symptoms including the rash, fever and gastrointestinal distress, doctors explained.

It is thought to be a post-infectious complication of the SARS-CoV-2 virus and was named Multisystem Inflammatory Syndrome Children, or MIS-C.

The CDC describe MISC-C as a condition where different body parts can become inflamed – including the heart lungs, kidney, brain, skin and eyes.

It is unknown what causes the condition but those children who have MISC-C also had SARS-CoV-2 or had been around someone with Covid-19.

It can be deadly but most children who develop the condition were able to recover with medical care and hospital treatment, the CDC explained.

Symptoms:

  • Fever
  • Abdominal pain
  • Vomiting
  • Diarrhoea
  • Neck pain
  • Rash
  • Bloodshot eyes
  • Feeling extra tired

Diagnosing the condition proved difficult as its symptoms were similar to those found in a range of childhood conditions – including the rash.

A study found that while there was no single rash placement, it was commonly found on lower limbs, the inner thigh, chest and upper extremities.

The rash usually appears as a 5p sized circle with tiny red spots in the centre. 

The CDC say the best way to protect a child from MIS-C is the work to limit exposure for the entire household to coronavirus by washing hands, social distancing and limiting how much you touch surfaces. 

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