Seborrheic dermatitis and anti‐COVID‐19 masks

Abstract

In Milan, Italy, after the end of the lockdown period (March and April 2020), we observed several patients with seborrheic dermatitis (SD) who showed a more or less important worsening of their disease. All patients used anti‐coronavirus‐19 (COVID‐19) face mask for many hours per day. According to the clinical point of view, the worsening was characterized by increased erythema and desquamation as well as itching worsened. In the last few weeks, some articles have been published on cases of dermatitis of the face associated with the use of anti‐COVID‐19 masks. Some authors hypothesized that this condition is due to high temperature of the face covered by the mask, that induces an increased sebum excretion rate. In our patients with SD, it is possible that high temperature of the face induces abnormalities of microbiota (proliferation of Malassezia spp.?) and permeability of skin barrier, and increases sweating with irritant action and worsening of itching.

Adverse skin reactions following different types of mask usage during the COVID‐19 pandemic

“…1 Wearing a mask is beneficial in lowering the risk of virus transmission. However, this measure is also known to cause various facial skin problems, 2,3 and their incidence might differ with the type of mask used. The primary objective of this study was to determine and compare the incidences of adverse skin reactions for the mask types used by the general population during the COVID-19 pandemic.…”

Occupational Dermatoses Related to Personal Protective Equipment Used During the COVID-19 Pandemic

“…It is thought that increased wear of facial PPE provides the ideal temperature and moist environment for Malassezia to grow and increases the risk to developing SD ( Table 3 ). 27 …”

“… 1 Rosacea Cheeks Doxycycline 40mg for 12 weeks Treatments provided clinical benefit Han C. et al 31 2020 China Non-HCWs 5 Acne Cheeks and nose Good response to Adapalene gel 0.1%, +/- face peel with 20% α-hydroxy acid Hu K. et al 22 2020 China HCWs 1 Acne Face Ferguson FJ. et al 16 2020 United Kingdom HCWs 16 Seborrheic Dermatitis Face 26 Acne 5 Rosacea Metin N. et al 24 2020 Turkey HCWs 82 Seborrheic Dermatitis Face and scalp 131 Acne/folliculitis Face Singh M. et al 17 2020 India HCWs 5 Acne Face Techasatian L., et al 25 2020 Thailand Both 333 Acne Face Trepanowski N. et al 32 2020 USA HCWs 11 Seborrheic Dermatitis Face 79 Acne 31 Rosacea Veraldi S. and Angileri L. 27 2020 Italy Both 20 Seborrheic Dermatitis Face …”

“…Long term use of facial PPE may increase the skin permeability and temperature, which causes a change in the microbiota allowing Malassezia to proliferate and thrive in these conditions leading to worsening SD. 27 During the COVID-19 pandemic, there have been several cases of SD exacerbated by facial PPE (see Table 3 ). A survey identified 37.5% of HCWs whose underlying SD had worsened due to facial PPE.…”

“… 24 Wearing facemasks for 6-10 hours per day exacerbated SD in 46.5% of patients in one series. 27 Of these patients with worsening symptoms, 75% were male and 35% of them worked in healthcare settings. 27 …”