The use of personal protective equipment (PPE) in the general population during the coronavirus disease 2019 (COVID-19) pandemic may be associated with the occurrence of facial dermatosis, according to a case series published in Clinical and Experimental Dermatology.

Italian investigators described 3 cases that have all occurred since the Italian government ended its strict lockdown on May 4, 2020, after which people in most regions of the country were required to wear a facial mask. Facial dermatoses related to prolonged use of PPE had previously been reported by frontline healthcare workers.

The first case was a 32 year-old woman who had a persistent bilateral erythematous rash on her cheeks 2 weeks after the end of the lockdown. She had a history of flushing and was wearing an N95 mask 6 hours per day at work. “We made a clinical diagnosis of rosacea and prescribed doxycycline 40 mg for 12 weeks,” noted the study authors.

The second case involved a 24 year-old woman who was diagnosed with occlusive acne and presented with numerous inflamed papules, pustules, and microcomedones on her chin and jaws bilaterally. She previously had facial seborrhea but had never developed similar acne lesions. She was wearing a facial mask and goggles for 8 hours/day at work and was prescribed adapalene 0.1% plus benzoyl peroxide 2.5% gel daily for 8 weeks and zinc gluconate 175 mg and nicotinamide 27 mg daily for 3 months.


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The third case was a 29 year-old man who had acute exacerbation of seborrheic dermatitis, with erythema and greasy scales on his nose, cheeks, and beard. He was treated with low-potency steroid cream for 5 days followed by pimecrolimus 1% ointment daily application for 10 days.

Facial protections “induce occlusion and consequently a damp and warm microenvironment,” which may lead to exacerbation of these conditions, noted the case report authors. “A surgical mask can be recommended instead of an N95 mask, if the work activity allows it.”

Treatment for patients with facial dermatoses should include tips about daily skin care, such as application of moisturizers before and after mask usage, the study authors advised.

“Treating these dermatoses [also] may prevent COVID-19 contagion, because facial skin damage increases itchy sensation, inducing persons to scratch the face and to remove [the] mask, with a reduction of PPE effectiveness,” the investigators commented.

Reference

Giacalone S, Minuti A, Spigariolo CB, et al. Facial dermatoses in general population due to personal protective masks: first observations after lockdown [published online July 13, 2020]. Clin Exp Dermatol. doi: 10.1111/CED.14376