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.

Evaluation, Prevention, and Management of Acne Scars: Issues, Strategies, and Enhanced Outcomes

Acne is a common disease affecting a high percentage of the younger population. Without appropriate and effective primary prevention of scarring, post-acne scars occur in about 80-95% of all patients. Acne scarring is the result of an alteration of the healing process and it can have deep psychosocial implications for patients. Scars can involve textural change in the superficial and deep dermis and it can also be associated with erythema or pigmentation. While the most effective strategy to reduce acne scarring is to prevent its formation, over the past decades, numerous aesthetic and surgical techniques have been proposed to improve the appearance of acne scarring. However, scar treatment still remains suboptimal; indeed, acne scarring management is a difficult therapeutic challenge for dermatologists. Several treatment options have been described to treat various acne scar types and clinical responses may differ from various factors, such as skin types. Treatment approaches for acne scarring should be individualized and primarily determined by the morphological features of each patient's scars. Dermatologists need to better organize their assessment of acne scarring and develop a multistep treatment plans tailored to address patients' individual needs. J Drugs Dermatol. 2018;17(12 Suppl):s44-48

Clinical Efficacy of a Novel Two-Part Skincare System on Pollution-Induced Skin Damage.

INTRODUCTION: Air pollution continues to be a global health concern and recent studies have shown that air pollutants can cause skin damage and skin aging through several pathways that induce oxidative stress, inflammation, apoptosis, and skin barrier dysfunction. Preventive measures need to be considered to retain optimal skin health, and topical skincare products may be able to alleviate the negative effects of air pollution on skin. A randomized, double-blind, placebo-controlled clinical usage study was conducted to assess the efficacy and tolerability of a novel two-part skincare system (LVS) that was developed to provide protection against environmental skin aggressors including air pollution. After 8 weeks of use in subjects exposed to extremely high levels of pollution, LVS provided significant improvements compared to placebo in all clinical efficacy parameters including crow's feet wrinkles, overall skin damage, skin tone evenness, tactile roughness, and visible redness. Subject self-assessment questionnaires showed that the treatment product was highly rated in self-perceived efficacy. Decreased SQOOH and MDA content in skin swab samples suggest that LVS helped to reduce oxidative stress in patients' skin. Histological analyses of biopsy samples using biomarkers related to skin structure, damage and function (collagen IV, MMP1, CPD, and CD1a) further support the clinical benefits of LVS. Altogether, the presented study is among the first to show that topical skincare products can help to reduce pollution-induced skin damage and improve skin quality, especially when specifically formulated with active ingredients that combat the harmful effects of air pollutants. J Drugs Dermatol. 2018;17(9):975-981.

Multifunctional photoprotection: corrective makeup for cutaneous dyschromias

The aim of this study was to develop and evaluate a corrective and photoprotective makeup for patients with dyschromias. An emulsion was prepared and pigment mixtures were incorporated in the formulation, producing five shades of corrective makeup: BEIGE (I, II, III), BRONZE and TAN. The sun protection factor (SPF) and UVA/UVB ratio of the corrective makeup were determined using spectrophotometry with a Labsphere® analyser. The spreadability, occlusivity, stability, and photostability of the photoprotective formulations were also evaluated. For all formulations there was no statistical difference among them (p > 0.05) in terms of spreadability, occlusivity and SPF. They were considered to be photostable under solar radiation, with variations in SPF value and UVA/UVB ratio lower than 20%. The corrective makeup presented average-to-high UVB photoprotection and broad spectrum photoprotection. After 90 days, pH, density and SPF values showed no significant differences among formulations (p>0.05). All corrective makeup presented separation of the pigments, however, they returned to a homogeneous aspect and to the original color shade after shaking. The corrective makeup presented a fine texture, little brightness, and a homogeneous, dry-to-the-touch aspect. This work may benefit patients with dyschromias, improving their quality of life, besides promoting photoprotection and covering the skin blemishes

Preventing facial pressure ulcers in patients under non-invasive mechanical ventilation: a randomised control trial.

OBJECTIVE: To comparatively assess the efficacy of four different therapeutic strategies to prevent the development of facial pressure ulcers (FPUs) related to the use of non-invasive mechanical ventilation (NIV) with oro-nasal masks in critically ill hospitalised patients. METHOD: This randomised control trial was performed at the high dependency unit in the University General Hospital Gregorio Marañón in Madrid, Spain. Overall, 152 patients with acute respiratory failure were recruited. All patients were hospitalised and received NIV through oro-nasal masks. The Norton tool was used to evaluate the general risk of developing pressure ulcers (PUs). Subjects were divided into four groups, each of them receiving a different treatment. Tissue assessment and preventive care were performed by a member of the research team. RESULTS: The incidence of FPUs was significantly lower in the group receiving a solution of hyperoxygenated fatty acids (HOFA) when compared with each of the other therapeutic strategies: direct mask (p=0.055), adhesive thin dressing (p=0.03) and adhesive foam dressing (p<0.001). CONCLUSION: The application of HOFA on the facial skin in contact with the oro-nasal masks showed the highest efficacy in the prevention of NIV-related FPUs.

Protective effects of a novel nutritional and phytonutrient blend on ultraviolet radiation-induced skin damage and inflammatory response through aging defense mechanisms.

BACKGROUND: The human body relies on several aging defense mechanisms (ADMs) to limit damage induced from pro-aging stressors (aging aggressors). However, such protective mechanisms can be compromised, leading to accelerated aging. The skin provides a model to probe the effects of an oral nutritional intervention on ADMs in response to ultraviolet radiation (UVR)-induced damage. OBJECTIVE: To determine whether supplementation with a novel nutritional and phytonutrient blend could protect against UVR-induced skin damage and positively influence facial skin attributes and characteristics by bolstering ADMs. METHODS: Thirty-six healthy, nonsmoking women (40-75 years) with Fitzpatrick skin types I and II were recruited. UVR-induced erythema and the number of apoptotic cells were determined before (pre-) and after 8-week (post-) supplementation. Other clinical variables included skin carotenoid concentrations, facial skin attributes and characteristics. RESULTS: Eight-week supplementation led to protection against UVR-induced skin damage as evidenced by reductions in erythema at all three minimal erythema doses (MEDs) (9.1 to 7.4 [P = 0.10]; 15.8 to 13.6 [P = 0.02]; and 19.6 to 17.3 [P = 0.01] for one, two, and three MEDs and a reduction in the average number of apoptotic cells [11.3 to 5.3, P < 0.0001] pre- and post-supplementation, respectively). Skin carotenoid concentrations increased from 28 111 Raman intensity units to 38 472 (P < 0.0001) along with noticeable improvements in facial skin attributes and characteristics: elasticity, transepidermal water loss, radiance, texture, and overall appearance (all P < 0.05) following supplementation. CONCLUSION: Eight weeks of oral supplementation positively impacted ADMs resulting in protection against UVR-induced skin damage and improvements in facial skin attributes and characteristics.

Face Masks for Noninvasive Ventilation: Fit, Excess Skin Hydration, and Pressure Ulcers.

BACKGROUND: Pressure ulcers (stages III and IV) are serious safety events (ie, never events). Healthcare institutions are no longer reimbursed for costs to care for affected patients. Medical devices are the leading cause of pediatric pressure ulcers. Face masks for noninvasive ventilation were associated with a high percentage of pressure ulcers at our institution. METHODS: A prospective cohort study investigated factors contributing to pressure ulcer development in 50 subjects using face masks for noninvasive ventilation. Color imaging, 3-dimensional surface imaging, and skin hydration measurements were used to identify early skin compromise and evaluate 3 interventions to reduce trauma: (1) a silicone foam dressing, (2) a water/polyethylene oxide hydrogel dressing, and (3) a flexible cloth mask. A novel mask fit technique was used to examine the impact of fit on the potential for skin compromise. RESULTS: Fifty subjects age 10.4 ± 9.1 y participated with color images for 22, hydration for 34, and mask fit analysis for 16. Of these, 69% had diagnoses associated with craniofacial anomalies. Stage I pressure ulcers were the most common injury. Skin hydration difference was 317 ± 29 for sites with erythema versus 75 ± 28 for sites without erythema (P < .05) and smallest for the cloth mask (P < .05). Fit distance metrics differed for the nasal, oronasal, and face shield interfaces, with threshold distances being higher for the oronasal mask than the others (P < .05). Areas of high contact were associated with skin erythema and pressure ulcers. CONCLUSIONS: This fit method is currently being utilized to select best-fit masks from available options, to identify the potential areas of increased tissue pressure, and to prevent skin injuries and their complications. Improvement of mask fit is an important priority for improving respiratory outcomes. Strategies to maintain normal skin hydration are important for protecting tissue integrity.

[Massive granuloma formation after long-term use of dermal fillers]. / Ausgeprägte Granulombildung nach langjähriger dermaler Fillerinjektion.

BACKGROUND: Since dermal fillers were introduced in 1981, millions of patients have undergone wrinkle treatment with dermal fillers. Except for autologous fat, all fillers can act as potential foreign bodies, which have the potential ability to induce an immune reaction. Persisting material may induce activation of the immune system and finally granuloma formation. Frequency, histology, and clinical presentation of such foreign body reactions may vary depending on the filler used. CASE REPORT: This case describes a patient who received innumerable filler injections over the last two decades presenting with massive facial granulomas.

[Keep an eye on the side effects]. / Nebenwirkungen im Auge behalten.

A 52-year-old man presented with a progressive grey-black pigmentation of facial skin, sclera and teeth. The cause was long-term ingestion of minocycline, as confirmed by history and skin biopsy. Minocycline-induced hyperpigmentation can be divided into four main patterns based on clinical appearance, distribution, light- and electron microscopic characteristics. Some patterns can manifest within weeks of initiating therapy. One must be alert to the early signs and warn the patient about the often cosmetically disturbing and persistent minocycline-induced hyperpigmentation.

Human demodicosis: revisit and a proposed classification.

Human Demodex mites (Demodex folliculorum and Demodex brevis) hold a high rank in the evolutionary and phylogenetic hierarchy of the skin microbiome, although in most people their presence is of no consequence. While human demodicosis is a skin disease sui generis, it can mimic many other inflammatory dermatoses, such as folliculitis, rosacea and perioral dermatitis, leading to unspecific and confusing descriptions in the literature. Here, we propose to classify human demodicosis into a primary form and a secondary form, which is associated mainly with immunosuppression. The clinical manifestations of primary demodicosis may include (i) spinulate demodicosis, currently known as pityriasis folliculorum, involving sebaceous hair follicles without visible inflammation; (ii) papulopustular/nodulocystic or conglobate demodicosis with pronounced inflammation affecting most commonly the perioral and periorbital areas of the face; (iii) ocular demodicosis, inducing chronic blepharitis, chalazia or, less commonly, keratoconjunctivitis; and (iv) auricular demodicosis causing external otitis or myringitis. Secondary demodicosis is usually associated with systemic or local immunosuppression. Treatment is only weakly evidence based, and the most effective concentrations of acaricides remain to be determined. Optimization of an in vitro or ex vivo culture model is necessary for future studies. Endosymbiosis between certain bacteria and Demodex mites in the pathogenesis of demodicosis deserves more attention. Further clinical observations and experiments are needed to prove our hypothesis.

A novel technique for preventing skin pressure sores using a rubber tube during surgical treatment of mandibular condyle fractures.

Craniofacial surgery occasionally results in sores and necrosis of the facial skin because of pressure from surgical instruments. During surgical treatment of mandibular condylar process fractures, the main mandibular fragment is routinely retracted downward using a wire to achieve a satisfactory anatomic reduction. This procedure may injure the facial skin. This potential complication is easily overlooked by medical staff, but it is easily preventable. We herein describe a method of using a rubber tube to avoid causing pressure sores of the facial skin during surgical treatment of mandibular condylar process fractures.