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Protection of skin barrier for Coronavirus with Personal Protective Equipment


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"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]

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 ShieldSafety 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]

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

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

 

 
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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

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