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Around helped people who wear face masks can develop acnefacial dermatitis, itching or pressure injuriesand the risk increases with the time the mask is worn, according to a recently published study systematic review and meta-analysis.
“This report finds that the most statistically significant risk factor for developing a facial dermatosis under a face mask is the length of time the mask is worn. Specifically, wearing a mask for more than 4 to 6 hours correlated most strongly with developing of a facial skin problem, said Jami L. Miller, MD, associate professor of dermatology, Vanderbilt University Medical Center, Nashville, Tennessee. Medscape Medical News. Miller was not involved in the study.
“The type of mask and the environment were of minor importance,” he added.
The use of masks for infection control has been common during the COVID-19 pandemic and will likely continue for some time, according to study co-authors Lim Yi Shen Justin, MBBS, and Yik Weng Yu, MBBS, MPH, PhD, Lee Kong Chinese School of Medicine, Nanyang. Singapore Technological University, wrote in an email to Medscape Medical News. And cross-sectional studies have suggested a link between mask wearing and various facial dermatoses.
To assess this link, as well as potential risk factors for facial dermatoses, researchers reviewed 37 studies published between 2004 and 2022 involving 29,557 adult participants who reported regular use of any type of face mask in 17 countries from Europe and Asia. (Types of masks commonly studied in the articles they analyzed included surgical masks and respirators.)
Facial dermatoses were self-reported in 30 studies (81.1%) and diagnosed by trained dermatologists in seven studies (18.9%).
Justin and Yu found that:
The overall prevalence of facial dermatoses was 55%
Individually, facial dermatitis, itching, acneand pressure injuries were consistently reported as facial dermatoses, with pooled prevalence rates of 24%, 30%, 31%, and 31%, respectively
Duration of mask use was the most important risk factor for facial dermatoses (P < .001)
Respirators, including N95 masks, were no more likely to be associated with facial dermatoses than surgical masks
“Understanding the risk factors of mask use, including the situation, duration and type of mask, may allow targeted interventions to mitigate the problems,” Yu said.
He advised taking a break from wearing masks after 4 to 6 hours to improve results.
Yew acknowledged limitations, including that most of the studies reviewed were based on self-reported symptoms.
“Patient factors were not investigated in most studies, therefore we were unable to determine their contributing role in the development of facial dermatoses from mask use,” he said. “We were also unable to prove causality between risk factors and outcome.”
Four dermatologists welcome the findings
Miller called this study “interesting and certainly relevant” now that mask-wearing is common and facial skin problems are fairly common complaints at doctor’s visits.
“As the authors say, irritants or contact allergens with longer exposures can be expected to cause more severe dermatitis than brief contact,” he said. “A longer duration can also cause occlusion of pores and hair follicles, which is expected to worsen acne and folliculitis.”
“I was surprised that the type of mask didn’t seem to matter significantly,” he added. “Patients who wear N95 masks can be relieved to learn that N95s do not cause more skin problems than lighter masks.”
Still, Miller had several questions, including whether materials and chemical finishes that vary by manufacturer can affect skin conditions.
Olga Bunimovich, MD, assistant professor in the department of dermatology at the University of Pittsburgh School of Medicine, Pennsylvania, called this study “an excellent step toward characterizing the role of face masks in facial dermatoses.”
“The study provides a window into the prevalence of these conditions, as well as some understanding of factors that might be contributing to it,” added Bunimovich, who was not part of the study. But “we can also use this information to alter behavior in the work environment, allowing ‘mask-free’ breaks to decrease the risk of facial dermatoses.”
Elma Baron, MD, professor and director, Skin Study Center, department of dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio, expected skin problems to be related to mask use but did not expect the prevalence was as high as 55%, which he called “very significant.”
“The use of masks is an important means of preventing the transmission of communicable infections, and the practice will most likely continue,” he said.
“Given the data, it is reasonable to advise patients who are already prone to these specific dermatoses to be proactive,” he added. “Early intervention with appropriate topical medications, preferably prescribed by a dermatologist or other health care provider, and frequent changing of masks before they become soaked with moisture, will hopefully lessen the severity of rashes and minimize the negative impact in quality of life”.
Commenting on the Justin and Yu study, Susan Massick, MD, dermatologist and clinical associate professor of internal medicine, The Ohio State University Wexner Medical Center, Westerville, said Medscape Medical News which urges people to wear masks, despite these risks.
“Most concerns are simple, manageable and generally benign,” he said. “We have a multitude of treatments that can help control, address or improve symptoms.”
“Masks are an effective and easy way to protect yourself from infection and remain one of the most reliable preventions we have,” Massick noted. “The findings in this article should not stop anyone from wearing a mask, nor should facial dermatoses be a cause for people to stop wearing their masks.”
contact dermatitis. Posted online August 18, 2022. summaries
The study received no funding. The authors, as well as Baron, Miller, Bunimovich, and Massick, who were not involved in the study, reported that they had no relevant financial relationships. All experts commented by email.