An epidemiological study on face masks and acne in a Nigerian population

Abstract

Background Acne vulgaris is a skin disorder that affects males and females with significant impact on quality of life. The onset of the COVID-19 pandemic led to a series of non-pharmaceutical interventions globally to reduce the spread of the virus particularly since there have been no known cures or definitive treatment for the disease. One key non-pharmaceutical intervention was recommendation on wearing of face masks. There are reports of discomfort associated with wearing face mask including complaints of various skin rashes, acne and headaches which could hinder appropriate use of face masks. While the dermatological problems associated with face mask use have been comprehensively explored in high income countries, the data is sparse in sub-Saharan Africa. We aimed to determine the association between face mask use and development of acne vulgaris in our developing country setting. We subsequently determined risk factors for development of acne vulgaris such as duration of wearing face masks, type of face mask, and prior dermatological skin condition history. We aimed to also determine the potential of acne development secondary to face mask use to reducing predisposition to wearing face masks. Methods This was an observational cross-sectional study conducted in within two local government areas of the Federal Capital Territory, Abuja. Trained interviewers administered pre-tested questionnaires to 1316 consecutive consenting adult participants randomly approached for informed consent at various public locations. Information was inputted into MS Excel and analyzed using Epi-info. Results A total number of 1316 persons participated in this study with mean age 34.4 ±12.3 years and median age 35.5years. Male: female ratio was 1:1.41. New onset acne or worsening of acne following consistent wearing of face masks was reported by 323 (24.5%) of the 1316 participants in this study. The surgical face mask was the least likely to predispose to acne p<0.05. Compared with the surgical mask, persons using N95 face mask and cloth mask were 1.89 and 1.41 times more likely to have acne respectively. Persons with prior history of acne were more likely to develop new acne or experience worsening of acne following wearing of face mask OR 3.89, 95% CI 2.85, 5.33; p <0.05). The length of time of daily mask wearing was not significantly associated with occurrence of new onset acne or worsening of acne. Persons reporting prior histories of allergy were more likely to develop acne in this study (OR 2.01, 95% CI 1.50, 2.88; p<0.05). In this study, 192 (59.4%) of those who reported having acne following face masks use responded they have a negative predisposition to wearing masks. Conclusion Our finding of greater predisposition to development or worsening of acne following consistent use of face masks could have implications for the control strategy of COVID-19. The finding that the N95 face mask was more significantly associated with acne is of concern as this is the preferred face mask in healthcare settings. It is important for the medical community to investigate feasible and safe recommendations to help alleviate this condition.

Facial mask-related acne during the coronavirus disease 2019 pandemic: a literature review

“…5 Study by Han et al, Ramesh et al and Shabari et al showed that the most reported symptoms of maskne were itching, pain, discomfort, stinging, sensation, burning sensation, dryness/tenderness, and excessive seborrhoea. 6,8,9,13 The most common signs were comedones, papules on cheek and nose, instead of nodules or cysts on forehead, submaxillary and neck. 5,8,13 Mask acne is thought to be a subtype of acne mechanica, for aggravation of the disease induced by an extrinsic factor that clearly intensifies acne, namely mechanical forces such are pressure, tension, friction, stretching, rubbing, pinching, or pulling, or almost any type of mechanical stress on the skin, although numerous other factors are implicated in its pathogenesis.…”

“…3,6,7 A person with prior history of acne vulgaris were about four times more likely to develop new acne lesions or experience worsening of their acne is logical and may be linked to their background predisposition to having acne prior to wearing face masks. 9 Studies proposed other risk factors may contribute to the development of acne, such as female HCW, younger HCW, those with a personal or family history of acne greater stress, the sleep deprivation HCW undergo during their shifts in COVID wards, and the consequent increasing in cortisol secretion. 4,15…”

“…The pathogenesis of PPE related acne is thought to be threefold: creation of a humid microclimate inside the mask; mucosa can be colonized by bacteria which could increase bacterial load on the surrounding skin; and friction effect of a close-fitting mask can damage the follicular ostia causing chronic irritation, and this effect is worsened by heat and humidity. 6,9,11,12…”

“…[4][5][6] The term 'maskne' refers to acne breakouts and acne-like eruptions the areas covered by face masks. 4,7,9 Acne vulgaris is a self-limiting, multifactorial disorder affecting the sebaceous glands and pilosebaceous follicles. 8 Some authors have linked the occurrence of maskne is likely a disorder of follicular occlusion, directly related to mechanical stress dysbiosis (pressure, occlusion, and friction) and microbiome (heat, pH, and moisture from biofluids).…”

“…2,5,[8][9][10][11][12][13] Acne may affect many aspects of an individual's quality of life in which acne may impacts greatly in one's psychological state. 3,9 In fact, maskne or mask-related acne is a well-recognized comorbidity due to PPE during COVID-19 pandemic both in HCW and less in the general population. 12 This review will be discussed current knowledge of maskne.…”