Periorbital erythema is a common cutaneous manifestation in COVID-19.

Dear Editor,

We read with great interest the recent elaborate review on the skin manifestations of COVID‐19 in children by Andina et  al., published recently in Clinical and Experimental Dermatology.

In general, the cutaneous manifestations of COVID‐19 are polymorphic nature. The cutaneous symptoms can be classified as: (i) urticarial rash, (ii) confluent erythematous/maculopapular/morbilliform rash, (ii) papulovesicular exanthem, (iv) chilblain‐like acral pattern, (v) livedo reticularis/racemosa‐like pattern and (vi) purpuric ‘vasculitic’ pattern. Various cutaneous manifestations of COVID‐19 including erythema multiforme, urticaria and Kawasaki disease‐like lesions were well discussed in the review, although one feature that we commonly observed in our case series was missing, namely, periorbital erythema.

A recent article by Young et  al. stated that the rate of periorbital erythema in patients with COVID‐19 infections could be as high as 20%. We believe that periorbital erythema should also be mentioned in this comprehensive review, as this paper has the potential for being a primary resource on the cutaneous manifestations of COVID‐19.

We would like to share the image of one of our patients in order to enrich the review’s collection (Fig. 1). This 6‐year‐old girl presented with the classic symptoms of multisystem inflammatory syndrome in children, including fever, abdominal pain, erythematous rash, conjunctival congestion and strawberry tongue. The levels of acute‐phase reactants (ferritin, interleukin‐6, procalcitonin and C‐reactive protein) were markedly increased, and COVID‐19 IgG was positive. The rashes started to fade on the fifth day of immunomodulatory treatment, and the treatment was stopped on the tenth day.

Figure 1

Periorbital erythema in a 6‐year‐old girl with positive IgG for COVID‐19, presenting with the classic symptoms of multisystem inflammatory syndrome.