Multisystem inflammatory syndrome (MIS-C) is a rare condition associated with COVID-19 affecting children, characterized by severe and aberrant systemic inflammation leading to nonspecific symptoms, such as gastrointestinal, cardiac, respiratory, hematological, and neurological disorders. In the last year, we have experienced a progressive reduction in the incidence and severity of MIS-C, reflecting the worldwide trend. Thus, starting from the overall trend in the disease in different continents, we reviewed the literature, hypothesizing the potential influencing factors contributing to the reduction in cases and the severity of MIS-C, particularly the vaccination campaign, the spread of different SARS-CoV-2 variants (VOCs), and the changes in human immunological response. The decrease in the severity of MIS-C and its incidence seem to be related to a combination of different factors rather than a single cause. Maturation of an immunological memory to SARS-CoV-2 over time, the implication of mutations of key amino acids of S protein in VOCs, and the overall immune response elicited by vaccination over the loss of neutralization of vaccines to VOCs seem to play an important role in this change.

Children with skin color (SOC) are underrepresented in dermatologic research, despite structural and functional differences that shape disease presentation. Atopic dermatitis (AD), one of the most common pediatric dermatoses, often appears differently in SOC than in white children. This study compared dermatologic conditions prompting Pediatric Emergency Department (PED) referral in SOC and white children, and described clinical features of AD in SOC. A retrospective study was performed at IRCCS AOUBO Policlinico di Sant’Orsola, Bologna, Italy, analyzing records and photographs from 2019. Patients presenting with dermatologic conditions and evaluated by a pediatric dermatologist were included. Of 411 patients, 109 (26.5%) had SOC. In SOC, common diagnoses were scabies (22%), AD (17.4%), viral infections (12.8%), burns (9.2%), and contact dermatitis (7.3%). In white children, viral infections (16.9%), burns (14.2%), contact dermatitis (13.9%), AD (12.9%), and insect bites (5.6%) predominated. Scabies and pruritus were significantly more frequent in SOC (p < 0.05). Among 38 SOC patients with AD, lichenoid (31.6%), pityriasis alba (29.0%), prurigo nodularis (26.3%), and classic AD (13.2%) were the most frequent variants. Erythema was often subtle or absent. Dermatologic conditions and AD morphology differ between SOC and white children, highlighting the need for tailored diagnostic approaches and equitable care.