Protection of Skin Barrier for Coronavirus with PPE and Rosacea

[Guide]

* image

"Since SARS-COV-2 pandemic began, frontline healthcare workers demonstrated to develop facial dermatoses, such as acne, rosacea and seborrheic dermatitis, secondary to prolonged use of personal protective equipment (PPE)." 
Clin Exp Dermatol. 2020 Jul 13;:
Facial dermatoses in general population due to personal protective masks: first observations after lockdown.
Giacalone S, Minuti A, Spigariolo CB, Passoni E, Nazzaro G

Personal Protective Equipment (PPE)
Personal Protective Equipment (PPE) includes among other items a facial mask, safety glasses, gloves, etc.  

Issues with PPE and Rosacea Sensitive Skin
You may be concerned with how to protect your skin as well as the mucous membrane, especially if you have issues with a mask irritating your rosacea sensitive skin. One paper on this subject states, "Insufficient and excessive protection will have adverse effects on the skin and mucous membrane barrier." [1] Another paper calls this 'Surgical Mask Dermatitis." [2] One paper discusses an allergic reaction to the elastic bands from certain PPE masks and noted, "Allergic contact dermatitis caused by elastic bands mask FFP2 (SIBOL, NR‐D, NUEVA SIBOL, Zamudio, Spain) was diagnosed. Complete clearance of dermatitis was achieved within 2 weeks after changing the mask to a type with cotton cloth bands." [3]

At least one report of a corneal abrasion from removing a face mask. [10]

"Of the people who wore face masks (three layers of surgical, cloth, respirators and half-face masks), 31.6% reported itch. Sensitive skin, atopic predisposition and facial dermatoses significantly predisposed users to the development of itch. The vast majority of subjects reported itch of moderate intensity. Itch in HCW may cause scratching and decrease the effectiveness of the necessary protection. The results indicate that face-mask-associated itch is an important problem, which should be addressed in future studies...Among the possible adverse effects of prolonged face mask use, authors frequently mention xerosis, rash, acne, facial dermatitis, pigmentation of the nasal bridge, chicks or chin and itching." [11]

"15.3% (360 individuals) reported skin changes on their faces during the pandemic. 4.9% of those with skin changes believed that they were due to the usage of face masks. However, the symptoms were mild for most (87.2%) of the patients. One hundred sixty-three of the participants were healthcare workers, and among them, 78.5% were working in hospitals." [12]

"Mask-related Koebner phenomenon is an important clinical sign to orient clinician's therapeutic protocols during COVID-19 pandemic, especially in patients with psoriasis." [13]

"Masks appear to trigger both acne and rosacea flares." [14]

"It has been reported that up to 97% of HCWs showed skin lesions (14), including acne, skin breakdown, rashes, contact and pressure urticaria, rosacea, perioral dermatitis, contact dermatitis, or aggravation of pre-existing skin disorders." [16]

Treatment for Skin Irritation Resulting from Using Protection
It has been recommended that, "using moisturizing products is highly recommended to achieve better protection." [1]. If you are concerned about wearing a mask, there are masks that may reduce skin irritation, i.e,, Anti-fog Full Face Shield, Anti-fog Adjustable Full Face Shield, Safety Face Shield.  In using goggles, one source states, "Over‐tight using cannot enhance the protective effect but damage the skin and generate fogs instead." [1] Some prefer the disposable paper mask. 

"Therapeutic measures for redness and swelling include hydropathic compress with three to four layers of gauze soaked by cold water or normal saline for about 20 minutes each time every 2 to 3 hours and then applying moisturizers. Avoid washing with over‐heated water, ethanol or other irritative products." [1] The paper recommends other therapeutic treatments if you are suffering from further damage to your skin. 

"After 3 days of anti‐allergic treatment (oral desloratadine and topical desonide cream), the lesions almost completely disappeared. The patient switched to other masks without sponge strips which were tolerated. No recurrence was found after 3‐month follow‐up." [4]

There is a report of an experience to skin reactions caused by personal protective equipment (PPE) during COVID-19 pandemic from a tertiary hospital in Granada, Spain and mentions a therapeutic approach to resolve this. [5] These ten step recommendations were made:

1. Avoid using makeup and other similar cosmetics during the working day
2. Avoid wearing jewellery and other decorative materials during the workday
3. Use cotton gloves as the first layer, and on top put the vinyl or nitrile gloves.
4. Change gloves every 30-40 minutes, whenever possible.
5. Handwashing with mild syndet soaps or oils, fragrance-free, and with the fewest preservatives possible.
6. Shower with warm water, short baths of no more than 10 minutes in length
7. Light touch drying of the skin after the shower, avoiding intense skin friction
8. Apply an emollient cream after the bath to the entire body surface.
9. Wash the scalp with mild or balancing shampoo.
10. Hands must be cared for more thoroughly. Among the care, a good rinse during hand washing is essential, and the application of emollient creams 2-3 times a day. The best time to apply it will be right after breakfast (before the workday), after eating (after the workday), and before going to bed (at this time higher fat emollients can be applied to increase the hydration of the skin). 

One report states, "frontline healthcare workers demonstrated to develop facial dermatoses, such as acne, rosacea and seborrheic dermatitis, secondary to prolonged use of personal protective equipment (PPE)." [7] 

"This study suggests that prolonged use of facemasks induces difficulty in breathing on exertion and excessive sweating around the mouth to the healthcare workers which results in poorer adherence and increased risk of susceptibility to infection." [8]

“We present a case of flare-up of rosacea in a nurse working in an Intensive Care Unit for COVID-19 patients, using FFP1 type mask at work and textile or paper mask outside the hospital.” [9]

Anecdotal Reports
"In the past week I am wearing Full Face Shield and it is much better." Obon, post no 7

There are a couple of threads on this subject at RF. [6]

Why not volunteer for the RRDi and post your experience using masks or any helpful suggestions you might have. Did you know that volunteering actually has benefits for you if your motive is to help other rosacea sufferers?

Etcetera

Rosacea and the Corona Virus

"The World Health Organization (WHO) named the disease 2019 coronavirus disease (COVID‐19) in February 2020." [15]

Reply to this Topic

There is a reply to this topic button somewhere on the device you are reading this post.

End Notes

[1] Dermatol Ther. 2020 Mar 29 : e13310.
Consensus of Chinese experts on protection of skin and mucous membrane barrier for health‐care workers fighting against coronavirus disease 2019
Yicen Yan,  Hui Chen,  Liuqing Chen,  Bo Cheng,  Ping Diao,  Liyun Dong

[2] Contact Dermatitis. 2020 May 28.  doi: 10.1111/cod.13626.  Online ahead of print.
Surgical Mask Dermatitis Caused by Formaldehyde (Releasers) During the COVID-19 Pandemic
Olivier Aerts, Ella Dendooven, Kenn Foubert, Sofie Stappers, Michal Ulicki, Julien Lambert 

[3] Contact Dermatitis. 2020 Jun 1 : 10.1111/cod.13600. doi: 10.1111/cod.13600 [Epub ahead of print]
Allergic contact dermatitis caused by elastic bands from FFP2 mask
Francisco J. Navarro‐Triviño, Carolina Merida‐Fernández,  Teresa Ródenas‐Herranz, Ricardo Ruiz‐Villaverde

[4] Contact Dermatitis. 2020 May 26 : 10.1111/cod.13599. doi: 10.1111/cod.13599 
Mask‐induced contact dermatitis in handling COVID‐19 outbreak
Zhen Xie, Yu‐Xin Yang,  Hao Zhang
* image courtesy of the above source

[5] Dermatol Ther. 2020 Jun 15;:e13838 PMID: 32543015
Therapeutic approach to skin reactions caused by personal protective equipment (PPE) during COVID-19 pandemic: An experience from a tertiary hospital in Granada, Spain.
Navarro-Triviño FJ, Ruiz-Villaverde R
The Full Text of this article is available as a PDF (1.3M).

[6] How are you all coping with face masks?

New Here and Anxious About Face Masks at Work 

[7] Clin Exp Dermatol. 2020 Jul 13 : 10.1111/ced.14376.doi: 10.1111/ced.14376 [Epub ahead of print]
Facial dermatoses in general population due to personal protective masks: first observations after lockdown
S. Giacalone,  A. Minuti,  C.B. Spigariolo,  E. Passoni,   G. Nazzaro

[8] Indian J Otolaryngol Head Neck Surg. 2020 Sep 15 : 1–7. 
Effects of Prolonged Use of Facemask on Healthcare Workers in Tertiary Care Hospital During COVID-19 Pandemic
P. K. Purushothaman, E. Priyangha, and Roopak Vaidhyswaran

[9] Maedica (Bucur). 2020 Sep;15(3):416-417
Flare-up of Rosacea due to Face Mask in Healthcare Workers During COVID-19.
Chiriac AE, Wollina U, Azoicai D

[10] Vis J Emerg Med. 2020 Dec 23 : 100958.
Corneal Abrasion from Removing Face Mask during the COVID-19 Pandemic
Sunny, Chi Lik Au, and Callie, Ka Li Ko

[11] Biology (Basel). 2020 Dec; 9(12): 451.
Increased Prevalence of Face Mask—Induced Itch in Health Care Workers
Piotr K. Krajewski, Łukasz Matusiak, Marta Szepietowska, Rafał Białynicki-Birula, and Jacek C. Szepietowski

[12] Dermatol Res Pract. 2020; 2020: 6627472.
The Prevalence and Determinants of Hand and Face Dermatitis during COVID-19 Pandemic: A Population-Based Survey
Mohammed Saud Alsaidan, Aisha H. Abuyassin, Zahra H. Alsaeed, Saqer H. Alshmmari, Tariq F. Bindaaj,  Alwa'ad A. Alhababi 

[13] Dermatol Ther. 2021 Feb 02;:e14823
Mask-Induced Koebner phenomenon and its clinical phenotypes: a multicenter, real-life study focusing on 873 dermatological consultations during COVID-19 pandemics.
Damiani G, Gironi LC, Kridin K, Pacifico A, Buja A, Bragazzi NL, Spałkowska M, Pigatto PD, Santus P, Young Dermatologists Italian Network, Savoia P

[14] Dermatol Ther. 2021 Feb 03;:e14848
COVID-19 related masks increase severity of both acne (Maskne) and rosacea (Mask rosacea): Multi-center, real-life, telemedical, observational prospective study.
Damiani G, Gironi LC, Grada A, Kridin K, Finelli R, Buja A, Bragazzi NL, Pigatto PD, Savoia P

[15] Int J Clin Pract. 2020 Dec 26 : e13948.
Comparison of patients’ diagnoses in a dermatology outpatient clinic during the COVID‐19 pandemic period and pre‐pandemic period
Dursun Turkmen, Nihal Altunisik, Irem Mantar, Imge Durmaz, Serpil Sener, Cemil Colak 

[16] Front Public Health. 2021; 9: 815415.
The Dermatological Effects and Occupational Impacts of Personal Protective Equipment on a Large Sample of Healthcare Workers During the COVID-19 Pandemic
Paolo Emilio Santoro,  Ivan Borrelli,  Maria Rosaria Gualano,  Ilaria Proietti,  Nevena Skroza,  Maria Francesca Rossi,  Carlotta Amantea,  Alessandra Daniele,  Walter Ricciardi,  Concetta Potenza, Umberto Moscato

 

 

[Guide]

Face shields and masks with exhalation valves were found to be less effective at protecting others from the coronavirus than normal face coverings, according to a study on Tuesday. 

New research, published in the journal Physics of Fluids, determined that the two options, which some wearers find more comfortable -- allowed ejected particles to escape, putting those around you in danger of being exposed to the virus.

The findings come amid an increasing trend of people replacing their regular cloth or surgical masks with clear plastic face shields, or masks equipped with exhalation valves.

Coronavirus: Face shields offer less protection for others than regular masks, study finds, FoxNews

[Mary]

Hi I am a rosacean and have a skin blog (All About Our Skin) where I have written about my rosacea disorder. Now with the COVID-19 pandemic this has brought new areas to discuss such as dealing with the mask and hand sanitizer. There is a difference between rosacea and the maskne that is receiving more attention since the pandemic started as being discussed above. I have also written about not wearing makeup and the care of the mask. I stumbled on this website doing my research. We need more support groups such as this and research to find a cure. I will provide your link on my site.

 

I have been wearing a cotton 2 layer mask that I wash and rotate with others. I wear this to grocery shop and for my part-time job that is physically demanding. This has been working fine for me. The thing is to clean face, hands and have a clean mask. There are also mask made of bamboo that may be an option, this I haven't tried. Anyone else try these? I was just reading reviews for the Ice Roller that some rosaceans find helpful. I have to get one of these!

[Guide]

"Facial masks and cosmetics were two of the most common products causing facial allergic reaction."

The association between rosacea and the condition of low-tolerance to skincare of the facial skin: a case-control study in China

[Guide]

There is a possible relationship between rosacea and the use of a continuous positive airway pressure (CPAP) mask for OSAS. 

Rosacea and Use of Continuous Positive Airway Pressure Mask for Obstructive Sleep Apnea Syndrome: Report of Five Cases

[Guide]

Prolonged wearing of Personal Protective Equipment (PPE), frequent handwashing, and disinfecting of surfaces have resulted in an increased number of skin complaints in both Health Care Workers (HCWs) and Non-Health Care Workers (non-HCWs).

"One study surveyed 542 HCWs and 97% reported skin damage caused by enhanced infection-prevention during the COVID-19 outbreak.9 The associated dermatoses include allergic contact dermatitis (ACD), irritant contact dermatitis (ICD), seborrheic dermatitis (SD), acne, and rosacea."

Dermatol Clin. 2021 May 31
Occupational Dermatoses Related to Personal Protective Equipment Used During the COVID-19 Pandemic
Selli Abdali, M.S. and JiaDe Yu, M.D.

[Guide]

"Our study showed that long‐term mask use caused primary skin symptoms, such as itching, redness, rash, dryness and peeling, burning, oily skin, and acne formation in individuals who have dermatological diseases, and also increased the existing dermatological facial diseases."

Dermatol Ther. 2021 May-Jun; 34(3): e14934.
Dermatological findings in patients admitting to dermatology clinic after using face masks during Covid‐19 pandemia: A new health problem
Esra İnan Doğan and Ferit Kaya 

[Guide]

"Prior studies have revealed the adverse effects (AEs) of PPE on healthcare workers (HCWs); however, no review has focused on the AEs of PPE on HCWs in intensive care units (ICUs). This review aimed to identify the AEs of PPE on HCWs working in ICUs during the COVID-19 pandemic."

SAGE Open Nurs. 2021 Jan-Dec; 7: 23779608211026164.
Adverse Effects of Personal Protective Equipment Among Intensive Care Unit Healthcare Professionals During the COVID-19 Pandemic: A Scoping Review
Takeshi Unoki, PhD, RN, Hideaki Sakuramoto, PhD, RN, Ryuhei Sato, PhD, RN,3 Akira Ouchi, PhD, RN, Tomoki Kuribara, MSN, RN, Tomomi Furumaya, MSN, RN, CCNS, Junko Tatsuno, PhD, RN, CCNS, Yuki Wakabayashi, MSN, RN, Asami Tado, PhD, RN, CCNS,8 Naoya Hashimoto, BSN, RN, Noriko Inagaki, MSN, RN, CCNS, Yoshiko Sasaki, PhD, RN,

[Guide]

'Face masks worn for at least 6 hours per day have resulted in allergic and irritant contact dermatitis, acneiform eruptions, atopy and seborrhoeic eczema, periorificial dermatitis, urticaria, rosacea, folliculitis, and pruritus...It is less clear how many hours or days that nonhealthcare individuals wear the same unsanitized face mask and whether exhaled, nasal, cutaneous, oral, oropharyngeal, and gastrointestinal organisms cultivated on the underside of the mask promote dysbiotic microbiomes and host illness."

Respir Med Res. 2021 Nov 27 : 100877.
PROLONGED FACIAL MASK WEAR IS A CONCERN FOR THE DEVELOPMENT OF DYSBIOTIC MICROBIOME
John K. Brooks, DDS, Clinical Professor, Ahmed S. Sultan, BDSPhD, Assistant Professor, and Mary Ann Jabra-Rizk, PhD, Associate Professor

[Guide]

"It has been reported that, because of occlusive effects of masks on the skin, some dermatitis of the face, such as acne, rosacea and seborrheic dermatitis, often worsen."

Mycopathologia. 2021 Dec 29 : 1–2.
“Mask” Tinea: An Increasing Infection during COVID-19 Pandemic
Paolo Bortoluzzi, Vinicio Boneschi, and Stefano Veraldi

------------------------------------------------------------------

"For occupations that require employees to be physically present at the workplace, such as, in the healthcare or service industries, this entails several hours of facial mask use every day. This extended mask wear can lead to prolonged cutaneous occlusion and contact with sensitizing chemicals. As a result, several dermatoses have been observed with facial mask use, including, irritant contact dermatitis, allergic contact dermatitis, flare of rosacea, and contact urticaria. A previous study found that skin adverse effects, including itching, rash, and acne, were common with N95 respirator use but not with surgical mask use."

J Clin Aesthet Dermatol. 2021 Oct; 14(10): 32–34.
Facial Mask-related Acne and Acneiform Eruption During the Coronavirus Disease 2019 Pandemic: A Case Series
Subuhi Kaul, MD, Ishmeet Kaur, MD, and Deepak Jakhar, MD

-----------------------------------------------------------------

A total of 954 cases of dermatological adverse effects were reported. Over 17 different adverse facial reactions were found, including the top 10 in order: itch (370, 38.8%), indentation/ear pain (102, 10.7%), discomfort (90, 9.4%), erythema (72, 7.5%), dryness (62, 6.5%), rash (60, 6.3%), scarring (42, 4.4%), desquamation (22, 2.3%), pain (19, 2.0%), burning (19, 2.0%), and wheals (7, 0.7%). Face masks can increase acne (n=44), rosacea (n=14), and seborrheic dermatitis (n=9).

J Clin Aesthet Dermatol. 2021 Sep; 14(9 Suppl 1): S39–S45.
Adverse Effects of COVID-19 and Face Masks: A Systematic Review
Akshitha Thatiparthi, BS, Jeffrey Liu, BS, Amylee Martin, BS, and Jashin J. Wu, MD

----------------------------------------------------------------

There is a real evidence of the rising prevalence of irritant and allergic contact dermatitis in response to the COVID-19 pandemic. The most commonly recorded symptoms are dryness, itch and redness of the skin. Nasal bridge, cheeks, forehead and hands represent the mainly affected skin sites.

Curr Treat Options Allergy. 2022 Feb 10 : 1–8.
Impact in Contact Dermatitis during and after SARS-CoV2 Pandemic
Graziella Babino, MD, Giuseppe Argenziano, MD, PhD, and Anna Balato, MD, PhD

[Guide]

Topical creams minimise facemask complications, thereby promoting compliance; topical lidocaine was the most effective in reducing pain and enabling facemask compliance. Topical hydrocortisone, diphenhydramine, and zinc oxide were effective in reducing facial redness, and topical petrolatum produced the best user satisfaction.

Facial topical cream promotes facemask tolerability and compliance during COVID-19 pandemic

[Guide]

"This is the first case report of demodicosis associated with wearing a face mask."

PubMed RSS Feed - -Demodicosis Associated with Wearing a Face Mask: A Case Report