The Impact of COVID-19 on the Faces of Frontline Healthcare Workers

September 2020 | Volume 19 | Issue 9 | Original Article | 858 | Copyright © September 2020

Published online August 14, 2020

Shino Bay Aguilera DO FAADa, Irene De La Pena MDb,c, Martha Viera MD FAADc, Bertha Baum DO FAAD FAOCDd, Brian W. Morrison MD FAADe, Olivier Amar MD ASPS BAPRAD SOF CPREf, Matthieu Beustes-Stefanelli MD MBAg, Mehreen Hall DOh

aShino Bay Cosmetic Dermatology, Fort Lauderdale, FL bAesthetic Medicine and Laser Therapy, Department of Aesthetic Medicina Universidad del Rosario, Bogotá, Colombia cDoral Dermatology Group, Doral, FL dHollywood Dermatology, Hallandale, FL ePhillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL fPlastic Reconstructive and Aesthetic Surgeon. London, United Kingdom gPlastic Surgery Unit, Maison Lutetia, Paris, France hLarkin Community Hospital Palm Springs Campus, Hialeah, FL

As the coronavirus epidemic continues, a host of new cutaneous complications is seen on the faces of frontline healthcare workers wearing personal protective equipment on a daily basis. To minimize the risk of COVID-19 infection, healthcare workers wear tight-fitting masks that lead to an excessive amount of pressure on the facial skin. Mechanical pressure, mask materials, and perspiration can all lead to various types of cutaneous lesions such as indentations of the face, skin tears, post-inflammatory hyperpigmentation, ulceration, crusting, erythema, and infection. The objective of this article is to provide effective and straightforward recommendations to those health care providers using facial masks in order to prevent skin-related complications.

J Drugs Dermatol. 2020;19(9):858-864. doi:10.36849/JDD.2020.5259


The worldwide pandemic of the novel and highly infectious Coronavirus disease 2019 (COVID-19) originated in Wuhan, China in December 2019.1 The etiology of this disease is due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which as of April 14, 2020, has affected more than 1.9 million people and taken the lives of more than 119,000 worldwide. Currently, it is speculated that the source of this infection is from bat-derived coronavirus, which spread to humans via an unknown intermediate mammal host.

The most frequent routes of transmission are airborne, droplets containing viable viruses, and direct/indirect contact with contaminated surfaces.2 Mucosal membranes that line various facial orifices are the most susceptible to viral transmission. Once the virus enters the body in any of the aforementioned routes, the single-stranded RNA-enveloped (ss-RNA) SARS-CoV-2 virus binds to the angiotensin-converting enzyme 2 (ACE-2) receptor. Once the virus makes contact with the target cell receptor, it enters the cell using the cell endosomes. This mechanism of action is facilitated by the cell's type 2 transmembrane serine protease, TMPRSS2 interacting with the virus S-spike protein. Once inside the cell, the virus takes over the cell’s machinery by first transmitting the ss-RNA into the cell's cytoplasm. Later, the cell is forced to translate the ss-RNA inside the cell's ribosome into viral polyproteins that encode for the replicase-transcriptase complex. Viral structural proteins are created inside the cell cytoplasm with the help of proteinase enzymes. At the same time, the virus makes the infected cell synthesize RNA via its RNA-dependent RNA polymerase. These components are created inside the cell for assembly and release of new viral particles.3

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a beta coronavirus now known to cause illness in humans. Since SARS-CoV-2 proteins bind to gastrointestinal and respiratory cells, they cause mild to severe respiratory and gastrointestinal symptoms.4 The incubation period is believed to be two to fourteen days following exposure. The signs and symptoms of COVID-19 infection range from asymptomatic to mild symptoms to severe respiratory symptoms and mortality. Risk factors for this infection include: adults older than forty or fifty years of age, male gender, pre-existing medical conditions, and lifestyle. Common initial symptoms of infection are fever, non-productive cough, shortness of breath, difficulty breathing, malaise, and fatigue. Less common symptoms are myalgias, headaches, confusion, diarrhea, and rhinorrhea. Twenty percent of individuals with COVID-19 may have a critical presentation of this infection. These symptoms range from pneumonia, renal