Some COVID-19 cases in kids may be mistaken for skin diseases, pediatricians warn

Pediatricians are warning that some COVID-19 cases in children may be going untreated or misdiagnosed as other viruses amid a rising number of positive patients whose only symptom is a skin rash.

Toronto pediatric emergency physician Dr. Dina Kulik told CTV News Channel on Tuesday she and her colleagues are seeing “a lot more” children and their adult caregivers presenting with what doctors assume is hand, foot and mouth disease (HFMD) because they are not showing any of the common symptoms of COVID-19.

However, changes in the skin and certain rashes have also been identified as symptoms of COVID-19 infection during the course of the pandemic.

Kulik said this is concerning because the misdiagnosis could lead to increased COVID-19 outbreaks in certain communities.

“My concern is that we’re saying to these families, ‘This is hand, foot and mouth, it’s a different virus, there’s no need to isolate for five days from your peers,’ we’re sending them maybe back into the world earlier than we should, and if it is a manifestation of COVID in fact… I worry that that could be spreading more of this illness,” Kulik said.

According to Health Canada, HFMD is a common viral illness that mainly affects infants and children, but can sometimes occur in adults.

Symptoms usually include painful, blister-like sores in and around the mouth, and a rash with or without small blisters, usually on the hands or fingers, feet or toes, and may also appear on other parts of the body. Those suffering from HFMD may also experience fever, loss of appetite, sore throat and a general feeling of being unwell.

The World Health Organization does list a new skin rash as one of the symptoms of COVID-19, but it is not one of the more common symptoms identified by Health Canada.

Despite this, Kulik suggests testing for COVID-19 if a new rash appears.

“I do believe that if your child or you are presenting with rash that if you have access to rapid antigen test, I do believe you should be swabbing right now,” she said.

Dr. Marina Malak, a family physician in Mississauga, Ont., told CTVNews.ca on Wednesday it can be difficult to identify COVID-19 infection in certain patients as the disease can present itself “in so many ways,” especially when it comes to children.

“The challenging thing with kids is they don’t always present in ‘typical COVID’,” Malak said in a telephone interview.

When examining children for infections, Malak said physicians will often ask about skin rashes because many childhood diseases present with a rash. She added that this might be the only symptom they’re presenting with, or symptoms progress after the onset of a rash.

Malak said this is not the first time children have presented with rashes in relation to COVID-19 infection.

“COVID toes,” which are characterized by rashes and inflammation in the toes and feet, as well as multisystem inflammatory syndrome (MIS-C), which causes inflammation in numerous parts of the body and resembles a rash similar to Kawasaki disease, are COVID-19 symptoms that have been more prevalent in children during the pandemic.

However, Malak noted no specific rash has been identified as belonging solely to COVID-19 infection.

“To our credit really as family doctors… we don’t really know if there’s a specific presentation of a COVID rash. There’s nothing to say this [skin rash] is for sure COVID,” she explained.

“However, I think with especially the rising cases right now and the fact that COVID really is prevalent, you really wouldn’t be wrong to do a COVID test.”

Malak said understanding the characteristics of a child’s rash is important in deciphering whether it is related to COVID-19, including whether the child has a history of skin rashes such as eczema.

She also advises parents to call their family doctor if they notice their child has a new rash.

Malak cautioned parents that just because a COVID-19 test is negative, it does not necessarily mean their child is in the clear.

“My fear is if people take a rapid antigen test when they notice a rash and then it’s negative, and they just think, ‘OK then, it’s not COVID’ or that it’s nothing serious,” Malak said. “Whether the rash ends up being related to COVID or not, it’s related to some other illness and we still need to treat that patient.”

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