Contact allergy investigations in healthcare workers with face mask-related skin disease.

BACKGROUND: During the COVID-19 pandemic, the use of face masks has increased among healthcare workers (HCWs). Questionnaire studies have shown a high frequency of self-reported facial adverse skin reactions. Case reports have been published on face mask-induced allergic contact dermatitis and urticaria. OBJECTIVES: To describe the results of the contact allergy investigations in consecutive HCWs investigated for skin reactions to face masks during the COVID-19 pandemic and the results of the chemical investigations of face masks supplied by the hospital. METHODS: Participants were patch tested with baseline series and chemicals previously reported in face masks not included in the baseline series. Face mask(s) brought by the HCW were tested as is and/or in acetone extract. Chemical analyses were performed on nine different face masks for potential allergens. RESULTS: Fifty-eight HCWs were investigated. No contact allergies were found to the face mask(s) tested. Eczema was the most common type of skin reaction, followed by an acneiform reaction. Colophonium-related substances were found in one respirator and 2,6-di-t-butyl-4-methylphenol (BHT) were found in two respirators. CONCLUSION: Based on this report, contact allergies to face masks is uncommon. Patch test with colophonium-related substances and BHT should be considered when investigating adverse skin reactions to face masks.

Facial dermatoses induced by face masks: A systematic review and meta-analysis of observational studies.

The use of masks for infection control was common in the COVID-19 pandemic. As numerous cross-sectional studies have suggested a link between the use of such masks and various facial dermatoses, a systematic review and meta-analysis of published studies was conducted to evaluate this association, as well as potential risk factors for the development of such facial dermatoses. Observational studies were searched for in MEDLINE, EMBASE and the Cochrane Central Register. Thirty-seven observational studies with a total of 29 557 study participants were identified. This study was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 checklist and quality was assessed via the Newcastle-Ottawa Quality Assessment Scale., Overall prevalence of facial dermatoses was 55%. Individually, acne, facial dermatitis, itch and pressure injuries were consistently reported as facial dermatoses, with a pooled prevalence of 31%, 24%, 30% and 31%, respectively. Duration of mask-wear was the most significant risk factor for the development of facial dermatoses (95% CI: 1.31-1.54, p < 0.001). Overall, facial dermatoses associated with mask wear are common, and consist of distinct entities. They are related to duration of use. Appropriate and tailored treatment is important to improve the outcomes for these affected patients.

The change in the frequency and severity of facial dermatoses and complaints in healthcare workers during the COVID-19.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has led to a dramatic increase in the use of personal protective equipment (PPE). However, the increased use of PPEs may lead to facial skin complaints. AIMS: This survey study aims to evaluate the effect of the COVID-19 pandemic on facial dermatoses and complaints. METHODS: A total of 1017 volunteers (age 18-60 years), consisting of healthcare workers, participated in the study. In the present study, healthcare professionals were screened for facial dermatoses and complaints between 1 and 15 April 2021 with an online survey. RESULTS: The vast majority of the survey were women (82.4%) and between 26 and 35 years old (49.2%). The most new-onset facial complaints were acne (25.3%) and lip dryness (29.2%). Along with the pandemic, 50.9% of patients with seborrheic dermatitis had an increase in lesions. Another remarkable result was a 60.5% increase in acne complaints. Moreover, the rate of exacerbations of rosacea, melasma, and lip dryness was increased after the COVID-19 pandemic (39.1%, 22.0%, and 42.7%, respectively). Exacerbations of seborrheic dermatitis, acne, and lip dryness have occurred more frequently in females when compared to males (p < 0.001). CONCLUSIONS: The current pandemic has had serious impacts on facial dermatoses which had to be managed carefully. Compared to the pre-pandemic period, there was a significant increase in the frequency and severity of complaints in facial dermatoses related to PPE. If the complaints that may develop due to PPE are known in advance, their development can be prevented by taking precautions against them.

Tinea incognito "mask"erading as allergic contact dermatitis due to COVID-19 facial covering in children.

We present three children with tinea incognito initially misdiagnosed as allergic contact dermatitis to face masks. All three patients presented with pruritic erythematous patches and plaques across the malar cheek and nose. This case series suggests that clinicians should keep a broad differential when evaluating mask-related facial dermatoses in children.

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.

"Face mask dermatitis" due to compulsory facial masks during the SARS-CoV-2 pandemic: data from 550 health care and non-health care workers in Germany.

BACKGROUND: During the COVID-19 pandemic, wearing face masks is mandatory not only for health care workers (HCWs) but also for the general population in many countries around the globe. OBJECTIVES: The aim of the study was to investigate the onset of adverse facial skin reactions due to compulsory face masks during the COVID-19 pandemic in HCWs and non-HCWs, and draw awareness of this new dermatological condition and its preventive measures. MATERIALS & METHODS: A questionnaire was distributed to 550 patients and HCWs from the Department of Dermatology and Allergy of the University Hospital Munich (LMU), Germany. Participants were surveyed regarding mask type, duration of usage and adverse facial skin reactions. Information on symptoms and the use of skin care products and topical drugs were retrieved. RESULTS: The duration of wearing masks showed a significant impact on the prevalence of symptoms (p < 0.001). Type IV hypersensitivity was significantly more likely in participants with symptoms compared to those without symptoms (p = 0.001), whereas no increase in symptoms was observed in participants with atopic diathesis. HCWs used facial skin care products significantly more often than non-HCWs (p = 0.001). CONCLUSION: Preventive and therapeutic measures should be established in order to avoid "face mask dermatitis", especially for people with underlying risk factors.

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.

Masks use and facial dermatitis during COVID-19 outbreak: is there a difference between CE and non-CE approved masks? Multi-center, real-life data from a large Italian cohort.

BACKGROUND: During the recent COVID-19 outbreak, masks became mandatory and shortages frequent, therefore the prevalence of non-CE (European Conformity Mark) approved masks increased in the general population. We aimed to quantify the prevalence of mask-related cutaneous side effects and the differences between CE and non-CE approved masks. METHODS: In this multicenter prospective observational study conducted from March 20, 2020 to May 12, 2020(during and after quarantine), patients attending emergency departments for a dermatological consult were clinically assessed and their masks were inspected to detect CE marks and UNI (Italian National Unification Entity) norms. Patients with history of facial dermatoses or under current treatment for facial dermatoses were excluded. RESULTS: We enrolled 412 patients (318 during quarantine and 94 after quarantine). CE-approved masks were observed 52.8% vs. 24.5%, whilst subsets of non-CE approved masks were 9.7% vs. 14.9% (Personal protective equipment (PPE)-masks), 16.4% vs. 12.8% (surgical masks [SM]), and 21.1% vs. 47.9%(non-PPE) and (non-SM masks), respectively during and after quarantine. Remarkably, non-CE-approved masks resulted in patients displaying a statistically significant higher incidence of facial dermatoses and irritant contact dermatitis compared to CE-approved masks, and these differences were mainly driven by non-PPE non-SM masks. Comparing quarantine and after quarantine periods, no statistically significant differences were found for CE-approved masks, whilst differences were detected in non-CE-approved masks regarding incidence of facial dermatoses (P<0.0001)and irritant contact dermatitis (P=0.0041). CONCLUSIONS: Masks are essential to prevent COVID-19 but at the same time higher awareness regarding mask specifications should be promoted in the general population. Non-PPE and non-SM masks should undergo more rigorous testing to prevent the occurrence of cutaneous side effects and future patients' lawsuit damages.

COVID-19: The experience from Beijing, China.

The epidemiology of coronavirus disease 2019 (COVID-19) in Beijing, China, is summarized. This presentation highlights its main clinical manifestations, including the skin findings in Beijing and sums up the cutaneous damage to the medical staff in their epidemic preventative work. Although there had been few COVID-19 patients who reported skin lesions in Beijing and even in China, dermatologists still needed to pay attention to self-protection in their daily work. Skin damage caused by protective equipment is very common in the majority of the medical staff in Beijing.

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

The recent coronavirus disease 2019 (COVID-19) pandemic has led to the dramatic increase in use of personal protective equipment (PPE) among health care providers and the general public. Herein the authors discuss the various occupational dermatoses including allergic and irritant contact dermatitis, acne, seborrheic dermatitis, and rosacea related to frequent handwashing, disinfecting of surfaces, and prolonged wear of various PPE including face masks, gloves, and gowns. The authors provide an overview of published PPE-associated occupational dermatoses during the COVID-19 pandemic and also discuss prevention strategies and treatment options to help patients with these complaints.

The Impact of COVID-19 on the Faces of Frontline Healthcare Workers.

As the coronavirus epidemic continues, a host of new cutaneous complications is seen on the faces of frontline healthcare workers wearing personal protective equipment on a daily basis. To minimize the risk of COVID-19 infection, healthcare workers wear tight-fitting masks that lead to an excessive amount of pressure on the facial skin. Mechanical pressure, mask materials, and perspiration can all lead to various types of cutaneous lesions such as indentations of the face, skin tears, post-inflammatory hyperpigmentation, ulceration, crusting, erythema, and infection. The objective of this article is to provide effective and straightforward recommendations to those health care providers using facial masks in order to prevent skin-related complications. J Drugs Dermatol. 2020;19(9):858-864. doi:10.36849/JDD.2020.5259.

Facial Pressure Injuries from Prone Positioning in the COVID-19 Era.

OBJECTIVE/HYPOTHESIS: This study aimed to determine the incidence of facial pressure injuries associated with prone positioning for COVID-19 patients as well as to characterize the location of injuries and treatments provided. METHODS: This was a retrospective chart review of 263 COVID-19 positive patients requiring intubation in the intensive care units at MedStar Georgetown University Hospital and MedStar Washington Hospital Center between March 1st and July 26th, 2020. Information regarding proning status, duration of proning, presence, or absence of facial pressure injuries and interventions were collected. Paired two-tailed t-test was used to evaluate differences between proned patients who developed pressure injuries with those who did not. RESULTS: Overall, 143 COVID-19 positive patients required proning while intubated with the average duration of proning being 5.15 days. Of those proned, 68 (47.6%) developed a facial pressure injury. The most common site involved was the cheek with a total of 57 (84%) followed by ears (50%). The average duration of proning for patients who developed a pressure injury was significantly longer when compared to those who did not develop pressure injuries (6.79 days vs. 3.64 days, P < .001). CONCLUSIONS: Facial pressure injuries occur with high incidence in patients with COVID-19 who undergo prone positioning. Longer duration of proning appears to confer greater risk for developing these pressure injuries. Hence, improved preventative measures and early interventions are needed. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E2139-E2142, 2021.

Contact dermatitis due to masks and respirators during COVID-19 pandemic: What we should know and what we should do.

Given the current lack of a therapeutic vaccine for coronavirus disease 2019 (COVID-19), preventive measures including mask wearing are crucial in slowing the transmission of cases. However, prolonged wearing of protective respirators, medical and fabric masks can easily generate excessive sweating, moisture and friction. Closed and warm environments heighten the skin's permeability and sensitivity to physical or chemical irritants, leading to chronic cumulative irritant contact dermatitis or, rarely, even allergic contact dermatitis. Although not representing a life-threatening condition, contact dermatitis can have a significant impact on emergency management, as it is potentially able to reduce work performance and create emotional discomfort due to the involvement of evident body areas. To minimize the skin breakdown, adherence to standards on wearing protective and safe equipments and avoidance of overprotection should be performed. At the same time, some measures of skin care are recommended. Here, we offer some tips on how to prevent and manage contact dermatitis due to masks not only in health care workers, but also in the general population during this COVID-19 outbreak.