Cutaneous manifestations of the COVID-19 pandemic in schoolchildren and adolescents

This review article focuses on cutaneous manifestations in schoolchildren and adolescents 6 to 18 years old connected with various aspects of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, including personal protective equipment (PPE), SARS-CoV-2 infection, and the SARS-CoV-2 vaccine. The use of PPE has been associated with mask-related acne due to microbiome dysbiosis and disruption of skin homeostasis, leading to the emergence of new acne or exacerbation of preexisting acne. Chilblain-like lesions, erythema multiforme-like eruptions, and cutaneous manifestations of multisystem inflammatory syndrome related to SARS-CoV-2 are the most commonly described skin manifestations of SARS-CoV-2 infection. The proposed mechanisms involve either the direct interaction of the virus with the skin through cutaneous receptor angiotensin-converting enzyme 2 in the epidermal basal layer or hyperactive immune responses. The impact of SARS-CoV-2 infection has also been described on adnexa, including hair changes such as alopecia areata and telogen effluvium, as well as nail changes presenting as onychomadesis and periungual desquamation. Cutaneous adverse effects of the SARS-CoV-2 vaccine have been described in case reports and differ from those in adults. Therefore, there is a need for increased awareness regarding the most prevalent cutaneous manifestations associated with COVID-19 in children because they tend to be mild or nonspecific in nature.