The Effects of the Face Mask on the Skin Underneath: A Prospective Survey During the COVID-19 Pandemic

Abstract

Purpose: The study aimed to explore the prevalence and possible risk factors to prevent the face mask related adverse skin reactions during the ongoing COVID-19 after a recommendation of face mask wearing for public use in Thailand. Results: The prevalence of face mask related adverse skin reactions was 454 cases (54.5%), of which acne was the most frequent (399; 39.9%), followed by rashes on the face (154; 18.4%), and itch symptoms (130; 15.6%). Wearing a surgical mask showed a higher risk of adverse skin reaction compared to a cloth mask, OR (95% CI) = 1.54 (1.16-2.06). A duration of face mask wearing of more than 4 hours/day and the reuse of face masks increased the risk of adverse skin reactions compared to changing the mask every day, adjusted OR(95% CI) = 1.96 (1.29-2.98), and 1.5 (1.11-2.02). Conclusion: Suggestions were made for wearing a cloth mask in non-health care workers (HCW) to decrease the risk of face mask related adverse skin reactions. This suggestion could potentially help in decreasing the demand of surgical masks which should be reserved for the HCW population during the ongoing COVID-19 pandemic.

Mask‐induced Koebner phenomenon and its clinical phenotypes: A multicenter, real‐life study focusing on 873 dermatological consultations during COVID‐19 pandemics

“…Masks also cause itch 32,33 and scratching derived injuries, the exact pseudo Koebner pathogenesis capable to explain KB related impetigo, warts, and molluscum contagiosum.…”

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

“…et al 16 2020 United Kingdom HCWs 69 Face Pressure from fitted mask and length of mask worn 110 Hands Chemicals from Clinell wipes (GAMA Healthcare, Watford, UK), benzalkonium chloride Hu K. et al 22 2020 China HCWs 58 Face Nasal bridge Ears Pressure from N95 Respirators 54 Hands Latex gloves 37 Body Disposable gowns worn 10 hours daily for 3.5 months Kiely LF. et al 23 2020 Ireland HCWs 26.28% Forehead Nose Cheeks Length of use of facial PPE 76.43% *223 total HCW – some complained of facial and hand dermatitis Hands Excessive handwashing Metin N. et al 24 2020 Turkey HCWs 194 Face Excessive face washing 782 Hands Excessive hand hygiene Excessive glove use 200 Body Excessive daily showering Singh M. et al 17 2020 India HCWs 28 Forehead Temple Ears Eyelids/canthus Cheeks and chin Nasal bridge Lips/Mouth Duration of wear and fitting of goggles, N95 respirators and face shields Techasatian L. et al 25 2020 Thailand Both 454 Ears Face Physical/frictional from ear straps and pressure from face masks HCW- Healthcare Worker …”

“… 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 …”

“…Among HCWs and non-HCWs, acne flares were the biggest complaint with facial PPE (39.9%). 25 The use of facial PPE for extended periods leads to a warm and humid environment under the PPE which can increase the sebum secretion rate and occlude pores leading to comedone formation predisposing to acne flare-ups. 31 During the 2003 SARS pandemic, 59.6% of HCWs complained of facial acne as one of the most difficult adverse skin reactions to wearing N95 respirators for many hours.…”

“… 32 HCWs had more symptoms compared to non-HCWs due to the increased duration of facial PPE worn and the use of N95 respirators. 25 Another study in non-HCWs showed cloth masks led to fewer acne flares compared to surgical masks. 21 It was recommended to decrease the flare ups, non-HCWs should use cloth masks instead of surgical masks.…”