Telemedicine Evaluation of Pediatric Acral Dermatitis in COVID-19 Era: A Real-Life Experience on COVID-19 Toes Versus Pool Palms and Review of the Literature on Juvenile Palmar Dermatitis

Introduction: SARS-CoV-2 infection is associated with different cutaneous manifestations, including chilblain-like lesions (“COVID-19 toes”), more frequently observed in younger patients. During the current COVID-19 pandemic, pediatric teledermatology has increased considerably since it allows to assist even children quarantined or living in distant geographic locations, also reducing long waiting times. Nonetheless, the correct clinical interpretation of skin lesions suspicious for being related to COVID19 represent a challenge for the dermatologist; in fact, many cutaneous diseases of both infectious and non-infectious origin, like pool palms (also known as “juvenile palmar dermatitis of swimming pools”), can simulate COVID-19 toes. Objectives: to report a telemedicine-assisted experience on outpatient pediatric cases affected by acral dermatitis during the current COVID-19 outbreak, highlighting a possible underdiagnosed differential diagnosis. Methods: We included 6pediatric cases, affected by acral acute dermatitis, for which, due to the ongoing pandemic, it was impracticable to conduct a face-to-face visit. We collected clinical data and high resolution images of skin lesions, which were independently examined by three different dermatologists. Results: We described the first three pediatric cases of pool palms reported in the COVID-era, comparing the clinical characteristics of three other pediatric patients affected by COVID-19 toes. We also performed a literature review of all pool palms cases published to date. Conclusions: Our real-life experience highlights the crucial rule of teledermatology during the ongoing pandemic. Furthermore, the paper emphasizes its criticalities, mainly related to the difficult collection of anamnestic data.