Facial dermatoses and use of protective mask during Covid‐19 pandemic: A clinical and psychological evaluation in patients affected by moderate–severe atopic dermatitis under treatment with dupilumab

Abstract

During the SARS‐COV‐2 pandemic, using face masks became mandatory in many countries. Although evidence suggests that masks can exacerbate several inflammatory skin diseases, few studies focus on their real impact on eczema localized to the face in atopic dermatitis (AD) patients. The aim of this study is to evaluate facial eczema prevalence during pandemic and its psychological impact in AD patients pre‐assessed for systemic treatment and/or in therapy with dupilumab. This study includes 71 patients affected by moderate–severe AD, treated with dupilumab at SCDU of Dermatology in Novara, Italy. We calculated the number of subjects with facial involvement in pre‐ and post‐pandemic periods and the related localization trend. We evaluated, in the two groups, clinical and psychological indicators recorded at each visit and the score modifications during the observational period. No statistically significant differences were observed in facial eczema prevalence, between pre‐ and post‐pandemic periods (p = 0.7618) and in facial eczema remission among the two groups (p = 0.1903). In post‐pandemic period, psychological scores were significantly lower (DLQI and HADS respectively with p < 0.0001 and p = 0.0025) and the reduction in EASI score during observational period was significantly greater (p = 0.0001). Our analysis revealed a potential protective effect of masks on face eczema, suggesting that they could enhance dupilumab efficacy. Face masks, covering sensitive areas, can positively contribute to mental distress in patients with facial eczema, and being associated with a lower allergic diseases incidence may sustain dupilumab in reducing AD severity.

National prevalence of atopic dermatitis in Korean adolescents from 2009 to 2022

“…Heavy metals exposure (a factor of air pollution) has similarly been associated with allergic diseases, acting as a direct activator of Th2 cells as well as an adjuvant, increasing the effect of other allergens 42 . In addition, the use of face masks has further enhanced the protective effect as studies have shown that they reduce allergic diseases, particularly AD 45 , 46 . While face masks could have an inflammatory effect on facial dermatoses due to increased skin hydration, temperature, and sebum secretion, it has been found that in patients with AD, facial eczema is deceased due to covering sensitive areas 46 .…”

“…In addition, the use of face masks has further enhanced the protective effect as studies have shown that they reduce allergic diseases, particularly AD 45 , 46 . While face masks could have an inflammatory effect on facial dermatoses due to increased skin hydration, temperature, and sebum secretion, it has been found that in patients with AD, facial eczema is deceased due to covering sensitive areas 46 . In 2022, many COVID-19 regulations began to be rescinded, with South Korea removing the mask mandate and other social restrictions as the pandemic started to wind down.…”