Prevalence of dermatological manifestations due to face mask use and its associated factors during COVID-19 among the general population of Bangladesh: A nationwide cross-sectional survey.

Following the worldwide COVID-19 pandemic, individuals have begun to take preventive measures to avoid exposure. Among the precautionary measures, facemask was mostly emphasized. This study aimed to determine the prevalence of dermatological symptoms linked with face mask usage and explore other associated factors. This cross-sectional survey was conducted throughout all eight divisions of Bangladesh. 1297 people were approached using a fixed-step procedure on a random route sample where 803 fulfilled the inclusion criteria. The overall prevalence of dermatological manifestation in this study was 40.85%. The common dermatological manifestations due to facemasks use were acne (26%), allergy symptoms (24%), traumatic symptoms (24%), and other symptoms (26%). Two important frequently reported risk factors were previous history of skin diseases and obesity. Females were more likely to have acne (CI: 1.199, 3.098; p = .007) and allergy issues (CI: 1.042, 2.359; p = .031). N95 and KN95 masks were more likely to produce allergic symptoms, while surgical mask users were more likely to develop acne. Acne was prevalent more than twice (CI: 1.42, 4.26; p = 0.001) in persons with a COVID-19 infection history. Further exploration is required to find out the reason. Surgical mask users reported more complaints than other types of masks, and prolonged use caused more skin symptoms. Modifications in the pattern of facemask usage and planning for work recesses might also be advised to provide for a pause from uninterrupted facemask use.

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

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.

The course of acne in healthcare workers during the COVID-19 pandemic and evaluation of possible risk factors.

BACKGROUND: There are a limited number of publications reporting an increase in acne in the COVID-19 outbreak. OBJECTIVE: The study aimed to evaluate the course and the clinical features of acne and possible risk factors during the COVID-19 pandemic in healthcare workers. METHOD: A total of 172 physicians (female, n = 159, male; n = 13, mean age = 35.03 ± 5.27 years) who had acne in any period of their life were included in the study. A self-administered online questionnaire was applied. RESULTS: During the COVID-19 pandemic, 45.35% of the participants reported that their acne complaints increased, 27.33% reported relapses, and 7.56% reported occurrence for the first time. Newly formed acne was reported most frequently on the chin (78.26%). The number of female participants, smoking, increased stress, and the rate of surgical mask use were found to be higher in the group whose acne occurred for the first time, relapsed, or increased than in the group whose acne complaints were unchanged or decreased (p < 0.05). In the group whose acne relapsed or increased, adult-onset acne, presence of scar, and use of systemic acne treatment before the COVID-19 pandemic were more common than in the group whose acne complaints were unchanged or decreased (p < 0.05). CONCLUSION: Almost half of the participants reported an increase in acne. More than a third of the participants reported that their acne relapsed or they had acne for the first time. In addition to the use of surgical masks, factors such as increased stress, smoking, adult-onset acne, presence of scar, and previous systemic acne treatment were found to be responsible for acne development.

Occupational facial dermatoses related to mask use in healthcare professionals.

BACKGROUND: Mask use can lead to facial dermatoses due to factors, such as hyperhydration, seborrhea, high humidity caused by sweating, and the occlusive effect of the mask. AIM: We investigated mask-related facial dermatoses in healthcare personnel who, since the beginning of the COVID-19 pandemic, had to wear a mask for long hours. METHODS: In this study, healthcare professionals working at Medipol Mega University Hospital since the beginning of the pandemic were screened for facial dermatoses between December 2020 and February 2021 with a dermatological examination and interview. RESULTS: Of the 101 healthcare professionals, 51 (50.5%) were doctors and 50 (49.5%) nurses, and 36 (35.6%) were male and 65 (64.4%) were female. All the participants had been actively working at the hospital for 35-46 weeks since the beginning of the pandemic and wearing N95 or surgical masks for an average of 6-13 h a day. During the dermatological examination, the most common facial dermatosis was acne, which was observed in 55.4% (n = 56) of the cases. Of the 56 acne cases, 41.1% (n = 23) had acne in their history, while 58.9% (n = 33) had new-onset acne. Being female, using a N95 surgical mask compared to surgical mask, and the daily average duration of mask use were determined as risk factors for acne development due to mask use. CONCLUSIONS: The use of masks, more frequently N95, caused both an increase in existing acne and the development of new acne.

Mask-induced dermatoses during the COVID-19 pandemic: a questionnaire-based study in 12 Korean hospitals.

BACKGROUND: During the coronavirus disease 2019 (COVID-19) pandemic, various adverse skin reactions to long-term mask wearing have been reported. AIM: To assess the clinical features of mask-induced dermatoses and to recommend prevention and treatment options. METHODS: From April to August 2020, questionnaires including topics such as demographic information, pre-existing skin disorders, reported mask-related symptoms, daily mask-wearing duration and frequency, types of masks used and whether the participant was a healthcare worker, were distributed to patients in 12 hospitals. Dermatologists assessed skin lesions, confirmed diagnosis and recorded treatments. RESULTS: Itchiness was the most frequent symptom, mostly affecting the cheeks. The most common skin disease was new-onset contact dermatitis (33.94%), followed by new-onset acne (16.97%) and worsening of pre-existing acne (16.97%). Daily wearing of masks was significantly (P = 0.02) associated with new-onset contact dermatitis. More than half of patients with pre-existing skin problems experienced disease worsening while wearing masks. Longer duration of wearing (> 6 h/day, P = 0.04) and use of cotton masks (P < 0.001) significantly increased acne flare-up. Healthcare workers had a higher incidence of skin disease. Skin lesions were generally mild and well tolerated with topical treatment. The study had some limitations: the effect of seasonal characteristics and other risk factors were not assessed, and the patients were visiting dermatological clinics and had interest in their skin status, thus, there may have been selection bias. CONCLUSION: Mask-induced/-triggered dermatoses contribute to increase the dermatological burden during the pandemic.

Adolescents' beliefs and perceptions of acne vulgaris: A cross-sectional study in Montenegrin schoolchildren.

BACKGROUND: Acne is a common chronic inflammatory skin disease with a high prevalence in adolescent and early adult years. The aim of this study was to assess the self-perceived beliefs of Montenegrin secondary school pupils regarding the acne aggravating and ameliorating factors. METHODS: This cross-sectional survey of the pupils was conducted during October and November 2020 in four randomly selected public secondary schools in Podgorica, Montenegro. All 500 pupils were asked to fill in a questionnaire that included questions on age, sex, presence of acne, perceived acne aggravating and ameliorating factors, and sources of their information about acne. RESULTS: A total of 500 pupils, 234 (46.8%) boys, and 266 (53.2%) girls, aged 14-17 years, participated in the study. Acne was self-reported in 249 (49.8%) pupils, whereas 251 (50.2%) did not report acne. Factors most often believed to aggravate acne were inadequate face washing (85.0%), hormones (84.0%), sweets (82.0%), greasy food (72.6%), makeup (71.2%), and stress (67.8%). Overall the most prevalent acne ameliorating factors were cosmetic treatment (80.4%), increased water consumption (77.6%), a diet change to a healthier food choice (77.4%), and being on school holidays (62.2%). Girls reported more frequently that genetics, stress, sweets consumption, inadequate face wash, and makeup are acne exacerbating factors, whilst cosmetic treatment, increased water consumption, smoking, and being on school holidays are acne ameliorating factors. Boys more frequently considered the benefit of losing weight. There was no statistically significant difference between pupils with and without acne in perceived factors, except for cosmetic treatment. Those with acne more frequently believed in the benefits of cosmetic treatment. CONCLUSIONS: Many adolescents' self-perceived beliefs about factors that aggravate and ameliorate acne are myths and misconceptions without evidence-based justification. More efforts are needed to educate pupils about the acne aggravating and ameliorating factors, its health-related consequences, and the treatment possibilities.