Biophysical and biochemical changes in skin health of healthcare professionals using respirators during COVID‐19 pandemic

Abstract

Background: Personal protective equipment, including respirator devices, has been used to protect healthcare workers (HCWs) during the COVID-19 pandemic. These are fitted to skin sites on the face to prevent airborne transmission but have resulted in reports of discomfort and adverse skin reactions from their continued usage. The present study addresses the objective changes in both the structural integrity and biological response of the skin following prolonged and consecutive use of respirators. Materials and methods:A longitudinal cohort study, involving 17 HCWs who wear respirators daily, was designed. Changes in the barrier properties and biological response of the skin were assessed at three facial anatomical sites, namely, the nasal bridge, left cheek and at a location outside the perimeter of respirator. Assessments were made on three different sessions corresponding to the first, second and third consecutive days of mask usage. Skin parameters included transepidermal water loss (TEWL), stratum corneum (SC) hydration and erythema, as well as cytokine biomarkers sampled from sebum using a commercial tape. Results:The cheek and the site outside the perimeter covered by the respirator presented minimal changes in skin parameters. By contrast, significant increases in both the TEWL (up to 4.8 fold) and SC hydration (up to 2.7 fold) were detected at the nasal bridge on the second consecutive day of respirator-wearing. There was a high degree of variation in the individual expression of pro-and anti-inflammatory cytokines. Increasing trends in nasal bridge TEWL values were associated with the body mass index (p < 0.05). Conclusions:The most sensitive objective parameter in detecting changes in the skin barrier proved to be the increase in TEWL at the nasal bridge, particularly on the second day of consecutive respirator usage. By contrast, other measures of skin were less able to detect remarkable variations in the barrier integrity. Consideration for protecting skin health is required for frontline workers, who continue to wear respirators for prolonged periods over consecutive days during the pandemic.

Characterisation of superficial corneocytes in skin areas of the face exposed to prolonged usage of respirators by healthcare professionals during COVID-19 pandemic

“…The study was conducted as previously published by Abiakam et al [ 11 ]. To review briefly, a convenience sample of HCWs were recruited from specific departments treating COVID-19 patients in a UK University Hospital Trust.…”

“…1 a). The assessment of biophysical skin parameters at these sites was performed as described previously in Abiakam et al [ 11 ]. In summary, TEWL, (Tewameter, Courage + Khazaka electronic GmbH, Germany), stratum corneum hydration (Corneometer, Courage + Khazaka electronic GmbH, Germany) and erythema was collected in the indicated order.…”

“…Biophysical skin parameters and sebum collection were performed pre- and post-respirator application. The skin response to respirator application (TEWL and SC hydration) was calculated as the ratio between pre- and post-shift biophysical skin values (normalized values), as previously described and presented in Abiakam et al [ 11 ].

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“…[ 10 ]. In a cohort of 17 HCWs, a recent study by Abiakam et al evaluated various biophysical skin parameters as well as the levels of certain inflammatory cytokines in sites exposed to prolonged respirator application [ 11 ]. The main finding included the consistent upregulation in Transepidermal water loss (TEWL) response particularly at the bridge of the nose, which coincided with high interface pressures at that location [ 12 ].…”

“…The present paper presents a complementary methodology and analysis of a previously published study on the biophysical and biochemical changes in skin health in HCWs during the COVID-19 pandemic [ 11 ]. It is focused on establishing the characteristics of superficial corneocytes, namely CE maturation and corneodesmosome distribution, in areas exposed to prolonged mechanical loading.…”