Changes in skin characteristics after using respiratory protective equipment (medical masks and respirators) in the COVID-19 pandemic among healthcare workers

Guarding skin under PPE: Mechanistic insights and technological innovations

In the presence of diseases transmitted through respiratory droplets and direct contact, healthcare workers (HCWs) necessitate the use of personal protective equipment (PPE). For optimal safety, PPE should securely conform to the skin during extended wear. However, conventional PPE often lacks adequate air permeability and hygroscopicity, trapping heat and moisture emitted by the body within the enclosure. Such a hot and humid internal environment can induce skin damage, such as erythema, rash, pruritus, and itching among others, leading to microbial growth on the skin surface, the production of inflammatory mediators at the wound site and an increased risk of infection. This review strives to comprehensively elucidate the fundamental mechanisms triggering adverse skin reactions and their resultant manifestations. Furthermore, we explore recent advancements aimed at inhibiting these mechanisms to effectively mitigate the occurrence of skin lesions.

Evaluation of Scalp Hydration and pH Values in Hijab-Wearing and Non-Hijab-Wearing Women

Introduction

Indonesia is the most populous Muslim-majority country, where some women wear hijab covering their scalp and neck. Some hijab-wearing women complain of scalp problems eg, itch, dandruff, and hair loss, which might be related to severe and chronic skin barrier impairment due to occlusion. Excessive water accumulation in the occluded stratum corneum might result in increased permeability, followed by increased skin pH values. This study aimed to evaluate scalp hydration and pH values in hijab-wearing and non-hijab-wearing women.

Material and Methods

This was a cross-sectional comparative analytical study using stratified random sampling methods conducted on 63 subjects, who were divided into two groups, consisting of 33 hijab-wearing and 30 non-hijab-wearing women. Both groups underwent physical examination and their medical history recorded. Scalp hydration was measured using a Corneometer (Courage + Khazaka, Koln, Germany), and scalp pH value was measured using a Skin & Scalp pH Tester (Hanna Instruments® HI981037, Rumania). This study was conducted at the Dermatology and Venereology Clinic of Hasan Sadikin General Hospital Bandung.

Results

The mean scalp hydration and pH values were 18.34 ± 2.91 AU and 4.93 ± 0.17, respectively, in hijab-wearing women. Meanwhile, the mean scalp hydration and pH values were 17.71 ± 3.35 AU and 4.91 ± 0.16, respectively, in non-hijab-wearing women. The difference of scalp hydration and pH values between the groups was not statistically significant based on the independent t-test, with p-values of 0.430 and 0.597, respectively.

Conclusion

Scalp hydration and pH values in hijab-wearing and non-hijab-wearing women did not differ significantly. Hijab-wearing women should not worry about scalp barrier impairment as long as they do not have any history of underlying scalp and skin disorders, and do not wear hijab in wet condition.

Characterisation of superficial corneocytes in skin areas of the face exposed to prolonged usage of respirators by healthcare professionals during COVID-19 pandemic

INTRODUCTION

During the COVID-19 pandemic healthcare workers (HCWs) have used respiratory protective equipment for prolonged periods, which has been associated with detrimental effects on the underlying skin. The present study aims to evaluate changes in the main cells (corneocytes) of the stratum corneum (SC) following prolonged and consecutive use of respirators.

METHODS

17 HCWs who wore respirators daily during routine hospital practice were recruited to a longitudinal cohort study. Corneocytes were collected via tape stripping from a negative control site (area outside the respirator) and from the cheek which was in contact with the device. Corneocytes were sampled on three occasions and analysed for the level of positive-involucrin cornified envelopes (CEs) and the amount of desmoglein-1 (Dsg1), as indirect measurements of immature CEs and corneodesmosomes (CDs), respectively. These were compared to biophysical measurements (Transepidermal water loss, TEWL, and SC hydration) at the same investigation sites.

RESULTS

A large degree of inter-subject variability was observed, with maximum coefficients of variation of 43% and 30% for the level of immature CEs and Dsg1, respectively. Although it was observed that there was not an effect of prolonged respirator usage on the properties of corneocytes, the level of CDs was greater at the cheek than the negative control site (p < 0.05). Furthermore, low levels of immature CEs correlated with greater TEWL values after prolonged respirator application (p < 0.01). It was also noted that a smaller proportion of immature CEs and CDs was associated with a reduced incidence of self-reported skin adverse reactions (p < 0.001).

CONCLUSIONS

This is the first study that investigated changes in corneocyte properties in the context of prolonged mechanical loading following respirator application. Although differences were not recorded over time, the levels of CDs and immature CEs were consistently higher in the loaded cheek compared to the negative control site and were positively correlated with a greater number of self-reported skin adverse reactions. Further studies are required to evaluate the role of corneocyte characteristics in the evaluation of both healthy and damaged skin sites.

Measuring the quantity of harmful volatile organic compounds inhaled through masks

An increase in the concentration of environmental particulate matter and the spread of the COVID-19 virus have dramatically increased our time spent wearing masks. If harmful chemicals are released from these masks, there may be harmful effects on human health. In this study, the concentration of volatile organic compounds (VOCs) emitted from some commonly used masks was assessed qualitatively and quantitatively under diverse conditions (including different mask material types, time between opening the product and wearing, and mask temperature). In KF94 masks, 1-methoxy-2-propanol (221 ± 356 µg m-3), N,N-dimethylacetamide (601 ± 450 µg m-3), n-hexane (268 ± 349 µg m-3), and 2-butanone (160 ± 244 µg m-3) were detected at concentrations 22.9-147 times higher than those found in masks made from other materials, such as cotton and other functional fabrics. In addition, in KF94 masks, the total VOC (TVOC) released amounted to 3730 ± 1331 µg m-3, about 14 times more than that released by the cotton masks (267.5 ± 51.6 µg m-3). In some KF94 masks, TVOC concentration reached over 4000 µg m-3, posing a risk to human health (based on indoor air quality guidelines established by the German Environment Agency). Notably, 30 min after KF94 masks were removed from their packaging, TVOC concentrations decreased by about 80% from their initial levels to 724 ± 5.86 µg m-3; furthermore, 6 h after removal, TVOC concentrations were found to be less than 200 µg m-3. When the temperature of the KF94 masks was raised to 40 oC, TVOC concentrations increased by 119-299%. Since the types and concentrations of VOCs that will be inhaled by mask wearers vary depending on the mask use conditions, it is necessary to comply with safe mask wearing conditions.

Patient safety implications of wearing a face mask for prevention in the era of COVID-19 pandemic: a systematic review and consensus recommendations

In the past, the use of face masks in western countries was essentially limited to occupational health. Now, because of the COVID-19 pandemic, mask-wearing has been recommended as a public health intervention. As potential side effects and some contraindications are emerging, we reviewed the literature to assess the impact of them in daily life on patient safety and to provide appropriate guidelines and recommendations. We performed a systematic review of studies investigating physiological impact, safety, and risk of masks in predefined categories of patients, which have been published in peer-reviewed journals with no time and language restrictions. Given the heterogeneity of studies, results were analyzed thematically. We used PRISMA guidelines to report our findings. Wearing a N95 respirator is more associated with worse side effects than wearing a surgical mask with the following complications: breathing difficulties (reduced FiO₂, SpO₂^, PaO₂ increased ETCO₂, PaCO₂), psychiatric symptoms (panic attacks, anxiety) and skin reactions. These complications are related to the duration of use and/or disease severity. Difficulties in communication is another issue to be considered especially with young children, older person and people with hearing impairments. Even if benefits of wearing face masks exceed the discomfort, it is recommended to take an "air break" after 1-2 h consecutively of mask-wearing. However, well-designed prospective studies are needed. The COVID-19 pandemic could represent a unique opportunity for collecting large amount of real-world data.

Biophysical and biochemical changes in skin health of healthcare professionals using respirators during COVID-19 pandemic

BACKGROUND

Personal protective equipment, including respirator devices, has been used to protect healthcare workers (HCWs) during the COVID-19 pandemic. These are fitted to skin sites on the face to prevent airborne transmission but have resulted in reports of discomfort and adverse skin reactions from their continued usage. The present study addresses the objective changes in both the structural integrity and biological response of the skin following prolonged and consecutive use of respirators.

MATERIALS AND METHODS

A longitudinal cohort study, involving 17 HCWs who wear respirators daily, was designed. Changes in the barrier properties and biological response of the skin were assessed at three facial anatomical sites, namely, the nasal bridge, left cheek and at a location outside the perimeter of respirator. Assessments were made on three different sessions corresponding to the first, second and third consecutive days of mask usage. Skin parameters included transepidermal water loss (TEWL), stratum corneum (SC) hydration and erythema, as well as cytokine biomarkers sampled from sebum using a commercial tape.

RESULTS

The cheek and the site outside the perimeter covered by the respirator presented minimal changes in skin parameters. By contrast, significant increases in both the TEWL (up to 4.8 fold) and SC hydration (up to 2.7 fold) were detected at the nasal bridge on the second consecutive day of respirator-wearing. There was a high degree of variation in the individual expression of pro-and anti-inflammatory cytokines. Increasing trends in nasal bridge TEWL values were associated with the body mass index (p < 0.05).

CONCLUSIONS

The most sensitive objective parameter in detecting changes in the skin barrier proved to be the increase in TEWL at the nasal bridge, particularly on the second day of consecutive respirator usage. By contrast, other measures of skin were less able to detect remarkable variations in the barrier integrity. Consideration for protecting skin health is required for frontline workers, who continue to wear respirators for prolonged periods over consecutive days during the pandemic.

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.

New Normal Mask-Wearing and Its Impact on Underneath Skin Microbiome: A Cross-Sectional Study in Mild Acne Vulgaris Patients

Introduction

Prolonged mask-wearing could modulate the skin microenvironment resulting in several facial dermatoses. Microbial dysbiosis is proposed to be linked with these changes; however, data regarding the association is still limited. Accordingly, we aimed to explore the impact of face masks on the skin's bacterial microbiota.

Methods

We classified participants into short (<4 h/day) and long (≥4 h/day) mask-wearing time (SMWT and LMWT) groups according to mask-wearing time per day in the previous 2 weeks. Specimens were swabbed from the cheek and forehead of 45 mild acne vulgaris patients, representing mask-covered area (MCA) and mask-uncovered area (MUA), respectively. The 16S rRNA gene sequencing and QIIME2 were used to characterize bacterial communities.

Results

There were 12 (26.7%) and 33 (73.3%) participants in SMWT and LMWT, respectively. There were no significant differences in beta diversity across MCA/MUA or LMWT/SMWT groups. In alpha-diversity, the evenness on MCA was significantly lower in LMWT than in SMWT (p value = 0.049). Among all groups, the relative abundance of bacterial taxa was similar, showing Actinobacteriota and Firmicutes, and Cutibacterium and Staphylococcus as the most predominant phyla and genera, respectively.

Conclusion

Our results showed no significant impact of mask-wearing on the skin microbiota in mild acne vulgaris participants.

Mask-related skin changes among healthcare workers in a community-based hospital

CONTEXT

During the COVID-19 pandemic, dermatologists within the Beaumont Farmington Hills' Dermatology program noticed an increase in conditions associated with mask wearing, such as "maskne" (acne in a mask distribution, thought to be caused by mask wearing), as well as worsening of previously diagnosed dermatologic conditions.

OBJECTIVES

The goal of our study was to explore various factors that impacted mask-related skin changes and how these skin changes affected quality of life.

METHODS

A cross-sectional study was performed. The primary 10-item survey instrument administered was the Dermatology Life Quality Index (DLQI). Respondents were asked a series of 10 additional questions concerning the degree to which abnormal mask-related skin conditions affect their skin symptoms, possible embarrassment/self-consciousness, and perceived impact of mask-related skin changes. A series of descriptive statistics, cross-tabulation charts, and graphical examinations of data was utilized to evaluate sample subgroup and outcome distributional patterns. Pearson r bivariate correlation coefficients between possible collinear predictive measures on the primary study outcome were calculated. A series of simple inferential chi-squared (Χ²) tests of independence were also conducted.

RESULTS

A total of 370 out of 430 (86.0%) Beaumont Health employees noticed some degree of skin changes since the work-hours face mask requirement was instituted, while 378 out of 430 (87.9%) felt that their skin was better when not wearing a mask. The majority of respondents, 283 (65.8%), reported having at least a little symptomatic skin (i.e., itchy, painful, sore, stinging) during the prior week. Furthermore, 72.3% reported that they were at least a little embarrassed or self-conscious of their skin. Chi-squared analysis of composite DLQI score categories by the number of types of masks utilized (Pearson X²=19.0, df=8, p=0.015), and some degree of symptomatic skin (Pearson X²=156.4, df=4, p<0.001) were found to be statistically significant.

CONCLUSIONS

A large number of healthcare workers are affected by mask-related skin changes. Further research should be directed at better understanding how skin changes associated with mask wearing impact one's quality of life and mental health.

Effects of one year of daily face mask wearing on the skin during the coronavirus disease 2019 pandemic

Background

As coronavirus disease 2019 (COVID‐19) continues, the long‐term daily use of masks is increasing. A full year includes the four seasons of spring, summer, autumn, and winter. Skin may have been affected by the seasons and further affected by the use of masks. In a previous study, we confirmed the short‐term and 6‐month effects of wearing face masks. In this study, we investigated how certain characteristics of the skin change when wearing a mask for 1 year. Furthermore, we compared skin covered by the mask (mask‐skin zone) to skin that was not covered.

Materials and methods

The participants were 18 healthy adults (8 men; 10 women) who were asked to wear masks in their daily lives from June 2020 to June 2021. During this period, participants’ skin characteristics, such as trans‐epidermal water loss, skin hydration, skin elasticity, skin keratin amount, skin pore area, skin temperature, skin redness, and skin color, were measured five times.

Results

Trans‐epidermal water loss, skin keratin amount, skin pore area, skin color, and skin elasticity changed significantly during the year. Furthermore, trans‐epidermal water loss, skin hydration, skin keratin amount, skin pore area, and skin color were significantly different between the mask‐wearing and non‐mask‐wearing areas of the face.

Conclusion

The skin characteristics of the mask‐skin zone can be affected by long‐term wearing of a face mask under lifestyle and environmental conditions. During the COVID‐19 pandemic, skin care for the mask‐skin zone is also necessary for people who do not wear masks on a daily basis.

Season- and facial site-specific skin changes due to long-term mask wearing during the COVID-19 pandemic

Background

As people have regularly worn facial masks due to the coronavirus disease 2019 (COVID‐19) pandemic, mask‐wear‐related adverse effects on the skin have been recognized. The aim of this study was to explore skin changes, their seasonal variations in the general population caused by commonly used masks and a possible mechanism underlying negative effects of mask‐wearing.

Materials and methods

Eighteen Japanese females participated in the study during summer and winter in Japan. Skin characteristics were measured in the non‐mask‐wearing preauricular area and the mask‐wearing cheek and perioral areas.

Results

Trans‐epidermal water loss (TEWL) on the cheek area tended to be increased in winter, which was positively correlated with skin scaliness on the same area. Ceramide (CER) content and composition in the mask‐covered stratum corneum (SC) were slightly changed between summer and winter, and CER [NP]/[NS] ratio was negatively correlated with the TEWL on the perioral skin in winter. Skin hydration and sebum secretion were higher on the cheek compared to the perioral area in summer. Skin redness was particularly high on the cheek in winter.

Conclusion

Mask‐wear‐related skin changes were season‐ and facial site‐specific, and alterations in SC CER may play a role in barrier‐related skin problems caused by mask use.

Spider Silk-Improved Quartz-Enhanced Conductance Spectroscopy for Medical Mask Humidity Sensing

Spider silk is one of the hottest biomaterials researched currently, due to its excellent mechanical properties. This work reports a novel humidity sensing platform based on a spider silk-modified quartz tuning fork (SSM-QTF). Since spider silk is a kind of natural moisture-sensitive material, it does not demand additional sensitization. Quartz-enhanced conductance spectroscopy (QECS) was combined with the SSM-QTF to access humidity sensing sensitively. The results indicate that the resonance frequency of the SSM-QTF decreased monotonously with the ambient humidity. The detection sensitivity of the proposed SSM-QTF sensor was 12.7 ppm at 1 min. The SSM-QTF sensor showed good linearity of ~0.99. Using this sensor, we successfully measured the humidity of disposable medical masks for different periods of wearing time. The results showed that even a 20 min wearing time can lead to a >70% humidity in the mask enclosed space. It is suggested that a disposable medical mask should be changed <2 h.

Biomechanical and Physiological Evaluation of Respiratory Protective Equipment Application

Purpose

Respiratory protective equipment is widely used in healthcare settings to protect clinicians whilst treating patients with COVID-19. However, their generic designs do not accommodate the variability in face shape across genders and ethnicities. Accordingly, they are regularly overtightened to compensate for a poor fit. The present study aims at investigating the biomechanical and thermal loads during respirator application and the associated changes in local skin physiology at the skin–device interface.

Materials and Methods

Sixteen healthy volunteers were recruited and reflected a range of gender, ethnicities and facial anthropometrics. Four single-use respirators were evaluated representing different geometries, size and material interfaces. Participants were asked to wear each respirator in a random order while a series of measurements were recorded, including interface pressure, temperature and relative humidity. Measures of transepidermal water loss and skin hydration were assessed pre- and post-respirator application, and after 20 minutes of recovery. Statistical analysis assessed differences between respirator designs and associations between demographics, interface conditions and parameters of skin health.

Results

Results showed a statistically significant negative correlation (p < 0.05) between the alar width and interface pressures at the nasal bridge, for three of the respirator designs. The nasal bridge site also corresponded to the highest pressures for all respirator designs. Temperature and humidity significantly increased (p < 0.05) during each respirator application. Significant increases in transepidermal water loss values (p < 0.05) were observed after the application of the respirators in females, which were most apparent at the nasal bridge.

Conclusion

The results revealed that specific facial features affected the distribution of interface pressures and depending on the respirator design and material, changes in skin barrier function were evident. The development of respirator designs that accommodate a diverse range of face shapes and protect the end users from skin damage are required to support the long-term use of these devices.

A pandemic-induced environmental dilemma of disposable masks: solutions from the perspective of the life cycle

The coronavirus disease 2019 (COVID-19) has swept the world and still afflicts humans. As an effective means of protection, wearing masks has been widely adopted by the general public. The massive use of disposable masks has raised some emerging environmental and bio-safety concerns: improper handling of used masks may transfer the attached pathogens to environmental media; disposable masks mainly consist of polypropylene (PP) fibers which may aggravate the global plastic pollution; and the risks of long-term wearing of masks are elusive. To maximize the utilization and minimize the risks, efforts have been made to improve the performance of masks (e.g., antivirus properties and filtration efficiency), extend their functions (e.g., respiration monitoring and acting as a sampling device), develop new disinfection methods, and recycle masks. Despite that, from the perspective of the life cycle (from production, usage, and discard to disposal), comprehensive solutions are urgently needed to solve the environmental dilemma of disposable masks in both technologies (e.g., efficient use of raw materials, prolonging the service life, and enabling biodegradation) and policies (e.g., stricter industry criteria and garbage sorting).

Facial Dermatoses and Use of Protective Mask During Covid-19 Pandemic: A Clinical and Psychological Evaluation in Patients Affected by Moderate-Severe Atopic Dermatitis Under Treatment With Dupilumab

During the SARS‐COV‐2 pandemic, using face masks became mandatory in many countries. Although evidence suggests that masks can exacerbate several inflammatory skin diseases, few studies focus on their real impact on eczema localized to the face in atopic dermatitis (AD) patients. The aim of this study is to evaluate facial eczema prevalence during pandemic and its psychological impact in AD patients pre‐assessed for systemic treatment and/or in therapy with dupilumab. This study includes 71 patients affected by moderate–severe AD, treated with dupilumab at SCDU of Dermatology in Novara, Italy. We calculated the number of subjects with facial involvement in pre‐ and post‐pandemic periods and the related localization trend. We evaluated, in the two groups, clinical and psychological indicators recorded at each visit and the score modifications during the observational period. No statistically significant differences were observed in facial eczema prevalence, between pre‐ and post‐pandemic periods (p = 0.7618) and in facial eczema remission among the two groups (p = 0.1903). In post‐pandemic period, psychological scores were significantly lower (DLQI and HADS respectively with p < 0.0001 and p = 0.0025) and the reduction in EASI score during observational period was significantly greater (p = 0.0001). Our analysis revealed a potential protective effect of masks on face eczema, suggesting that they could enhance dupilumab efficacy. Face masks, covering sensitive areas, can positively contribute to mental distress in patients with facial eczema, and being associated with a lower allergic diseases incidence may sustain dupilumab in reducing AD severity.

P2/N95 respirators & surgical masks to prevent SARS-CoV-2 infection: Effectiveness & adverse effects

BACKGROUND

Millions of people have acquired and died from SARS-CoV-2 infection during the COVID-19 pandemic. Healthcare workers (HCWs) are required to wear personal protective equipment (PPE), including surgical masks and P2/N95 respirators, to prevent infection while treating patients. However, the comparative effectiveness of respirators and masks in preventing SARS-CoV-2 infection and the likelihood of experiencing adverse events (AEs) with wear are unclear.

METHODS

Searches were carried out in PubMed, Europe PMC and the Cochrane COVID-19 Study Register to 14 June 2021. A systematic review of comparative epidemiological studies examining SARS-CoV-2 infection or AE incidence in HCWs wearing P2/N95 (or equivalent) respirators and surgical masks was performed. Article screening, risk of bias assessment and data extraction were duplicated. Meta-analysis of extracted data was carried out in RevMan.

RESULTS

Twenty-one studies were included, with most having high risk of bias. There was no statistically significant difference in respirator or surgical mask effectiveness in preventing SARS-CoV-2 infection (OR 0.85, [95%CI 0.72, 1.01]). Healthcare workers experienced significantly more headaches (OR 2.62, [95%CI 1.18, 5.81]), respiratory distress (OR 4.21, [95%CI 1.46, 12.13]), facial irritation (OR 1.80, [95%CI 1.03, 3.14]) and pressure-related injuries (OR 4.39, [95%CI 2.37, 8.15]) when wearing respirators compared to surgical masks.

CONCLUSION

The existing epidemiological evidence does not enable definitive assessment of the effectiveness of respirators compared to surgical masks in preventing infection. Healthcare workers wearing respirators may be more likely to experience AEs. Effective mitigation strategies are important to ensure the uptake and correct use of respirators by HCWs.

The Emotional Impact of Maskne in the Era of COVID-19: A Commentary on the Future of a Multi-Modality Approach

Over the past two years, the world has experienced the destructive effects of the SARS-CoV-2 pandemic, better known as COVID-19. The use of surgical face masks was declared necessary by many governments around the world to protect citizens from catching the rapidly spreading virus. Albeit surgical masks contributing to stopping the spread of SARS-CoV-2, many people have reported rashes closely resembling acne on their chins ever since wearing face masks became mandatory. This article studies the acne that results from masks worn to prevent the transmission of the SARS-CoV-2. Acne due to the wearing of masks (“Maskne”) is a new challenge that has affected the population and can decay the mental health of societies and individuals. The exploration of the mental and physical health effects of “Maskne” help us to form treatments that emphasize the association of improving mental health to decrease acne and enhancing quality of life.

Enhanced Fluctuations in Facial Pore Size, Redness, and TEWL Caused by Mask Usage Are Normalized by the Application of a Moisturizer

Mask wearing is described as one of the main public health measures against COVID-19. Mask wearing induces various types of subjective and objective facial skin damage, such as hair pore dilatation and redness. Facial pore size and redness show morning-to-evening intra-day fluctuations. It remains unknown whether mask usage affects fluctuations in pore size and redness. We measured facial skin hydration, transepidermal water loss (TEWL), pore size, and redness four times a day for 6 weeks in 20 healthy young women. After a 2-week no-mask-usage period (baseline period), all subjects wore unwoven masks for 2 weeks; then, for the following 2 weeks, they applied masks after the topical application of a moisturizer containing a Galactomyces ferment filtrate (GFF) skin care formula (Pitera™). We demonstrated that mask wearing significantly increased the intra-day fluctuations of pore size, redness, and TEWL. In addition, significant correlations were evident among these three parameters. Notably, these mask-induced skin changes were significantly improved, achieving a return to baseline levels, by the application of a GFF-containing moisturizer. In conclusion, mask wearing aggravates intra-day fluctuations in pore size and redness. Appropriate moisturization can minimize this mask-related skin damage, most likely by normalizing the elevated TEWL.

Novel insights into contact dermatitis

Contact dermatitis is a common disease, caused by repeated skin contact to contact allergens or irritants, resulting in allergic contact dermatitis (ACD) and/or irritant contact dermatitis. Attempts have been made to identify biomarkers to distinguish irritant and allergic patch test reactions, which could aid diagnosis. Some promising candidates have recently been identified, but verification and validation in clinical cases still need to be done. New causes of ACD are constantly recognized. In this review, 10 new contact allergens from recent years, were identified, several relating to anti-age products. Frequent allergens causing considerable morbidity in the population such as the preservative methylisothiazolinone (MI) have been regulated in EU. A significant drop in cases has been seen, while high rates are still occurring in other areas such as North America. Other frequent causes are fragrance allergens especially widely used terpenes and acrylates used in medical devises for control of diabetes. These represent unsolved problems. Recent advances in immunology have opened for a better understanding of the complexity of contact dermatitis, especially ACD. The disease may be more heterogenous that previous understood with several subtypes. With the rapidly evolving molecular understanding of the disease, the potential for development of new drugs for personalized treatment of contact dermatitis is considerable.

Changes in skin characteristics after using respiratory protective equipment (medical masks and respirators) in the COVID-19 pandemic among healthcare workers

BACKGROUND

The coronavirus disease-2019 (COVID-19) outbreak has presented unique dermatologic challenges due to respiratory protective equipment (RPE)-related skin conditions.

OBJECTIVE

To objectively evaluate the effects of RPE including medical masks and respirators on the skin barrier by measuring various physiological properties of the skin.

METHODS

A cross-sectional study was designed. Twenty healthy healthcare workers were included in this study. Skin parameters including skin hydration, transepidermal water loss (TEWL), erythema, sebum secretion, pH, and skin temperature were measured in the RPE-covered and RPE-uncovered areas of the face 4 and 8 hours after wearing RPE and 14 hours after not wearing RPE.

RESULTS

Skin hydration, TEWL, erythema, pH, and skin temperature increased in the RPE-covered areas after wearing RPE for 4 and 8 hours. By contrast, in the RPE-uncovered areas, skin hydration decreased and TEWL, erythema, and pH showed minimal changes over time. Based on the repeated-measure analysis, the changes in skin physiological properties over time were significantly different between RPE-covered and RPE-uncovered areas.

CONCLUSION

We observed that skin physiological characteristics change with the prolonged use of RPE such as medical masks and respirators. These changes may lead to various adverse skin reactions after long-term use.

Facial masks vestibulitis: the risk of mismanagement in the COVID-19 pandemic

The COVID-19 pandemic has forced the global population to adopt several public health measures, including social distancing, environmental disinfection and use of personal protective equipment (PPE), which are still widely recommended although several vaccines are currently available. Dermatological and allergological diseases related to the extended use of the PPEs represent an emerging problem amidst the pandemic. In particular, there are increasing reports of skin damage, occupational dermatoses, Irritant Contact Dermatitis (ICD) and allergic contact dermatitis (ACD) related to surgical facemasks and N95. We report the case of a superinfected ICD of the narinal region complicated in nasal vestibulitis, characterized by purulent secretions, narinal edema and nasal obstruction, with the aim of highlighting that even the incorrect use of protective against Covid-19 transmission can cause the onset of severe diseases.