key: cord-0864828-f3j1ciw2 authors: Altun, Ece; Topaloglu Demir, Filiz title: Occupational facial dermatoses related to mask use in healthcare professionals date: 2021-08-27 journal: J Cosmet Dermatol DOI: 10.1111/jocd.14415 sha: 8c4e0dd9361dd70a267cd7b28bfbd650b5e10964 doc_id: 864828 cord_uid: f3j1ciw2 BACKGROUND: Mask use can lead to facial dermatoses due to factors, such as hyperhydration, seborrhea, high humidity caused by sweating, and the occlusive effect of the mask. AIM: We investigated mask‐related facial dermatoses in healthcare personnel who, since the beginning of the COVID‐19 pandemic, had to wear a mask for long hours. METHODS: In this study, healthcare professionals working at Medipol Mega University Hospital since the beginning of the pandemic were screened for facial dermatoses between December 2020 and February 2021 with a dermatological examination and interview. RESULTS: Of the 101 healthcare professionals, 51 (50.5%) were doctors and 50 (49.5%) nurses, and 36 (35.6%) were male and 65 (64.4%) were female. All the participants had been actively working at the hospital for 35–46 weeks since the beginning of the pandemic and wearing N95 or surgical masks for an average of 6–13 h a day. During the dermatological examination, the most common facial dermatosis was acne, which was observed in 55.4% (n = 56) of the cases. Of the 56 acne cases, 41.1% (n = 23) had acne in their history, while 58.9% (n = 33) had new‐onset acne. Being female, using a N95 surgical mask compared to surgical mask, and the daily average duration of mask use were determined as risk factors for acne development due to mask use. CONCLUSIONS: The use of masks, more frequently N95, caused both an increase in existing acne and the development of new acne. about their dermatological conditions before and after mask use and underwent a dermatological examination, after which a clinical diagnosis was made. The Global Acne Grading System (GAGS) was used to determine the clinical severity of acne. 18 SPSS v. 15 .0 for Windows was used for statistical analyses. Descriptive statistics were presented as numbers and percentages for categorical variables, and mean and standard deviation for numerical variables. The rates in independent groups were compared using the chi-square test. Since numerical data did not meet the normal distribution assumption, the comparison of two independent groups was undertaken with the Mann-Whitney U test. Determinative factors were examined using the logistic regression analysis. The statistical alpha significance level was accepted as p < 0.05. A total of 101 healthcare professionals, 36 (35.6%) male and 65 (64.4%) female, were included in the study. The participants consisted of 51 (50.5%) doctors and dentists and 50 (49.5%) nurses (service and intensive care unit), and the mean age was 30.0 ± 7.5 years. The participants had been wearing masks for an average of 40.7 ± 3.5 (35-46) weeks for an average of 10.8 ± 1.3 (6-13) h per day, and 34 participants most commonly used N95 (33.7%) while 67 (66.3%) used surgical masks. The characteristics of the participants of the study are summarized in Table 1 . The dermatological physical examination revealed that 56 (55.4%) of the participants had acne vulgaris, two (2%) had acne rosacea, one (1%) had seborrheic dermatitis, and one (1%) had contact dermatitis. These patients stated that their lesions increased with mask use. Thirteen (23.2%) of the acne cases were male and 43 (76.8%) were female. Twenty-three (41.1%) of the patients had a history of acne before mask use, while 33 (58.9%) had no history of acne. Among all the participants, the rate of new-onset acne was found to be 32.7%. Of the participants with acne who had been wearing masks for an average of nine to 13 (11) h a day for 35-46 (40.5) weeks, 36 (64.3%) used surgical masks and 20 (35.7%) used N95 masks. Factors that can be associated with acne development are summarized in Table 2 . Being female compared to male and longer daily working hours were found to be statistically significant risk factors for the development of acne. In 55 (98.2%) of the 56 cases that were detected to have acne during the dermatological examination, acne was severe in the mask area (right cheek, left cheek, chin, and nose) than the non-mask area (chest and upper back, and forehead), and 54.5% of the participants described an increase in acne with mask use. Of the participants, 32.7% had new-onset acne and 22.8% had the activation of existing acne. In one (1.8%) case, acne was more severe in the non-mask area (chest and upper back, and forehead), and mask use did not increase acne severity. Twenty-three (41.1%) cases had a history of acne before mask use but described an increase in the severity of acne with mask use, while 33 (58.9%) cases did not have a history of acne before mask use and stated that this problem emerged with the use of masks. Areas of acne lesions and lesion types recorded during the dermatological examination of the patients are summarized in Table 3 . Among the individuals who developed acne due to mask use, the most common lesion area was the chin (n = 42, 41.6%), and the common lesion type was a papule (n = 22, 21.8%). Of the 56 acne cases, 55 (98.2%) had mild acne and one (1.8%) had moderate acne. The mean GAGS score of those with a history of acne was statistically significantly higher than those who did not have a history of this disease (p < 0.001). In the univariate analysis, there was a relationship between mask type and mask-related acne development based on the significance level of p < 0.250, and N95 was determined as a risk factor compared Table 4 . With the backward method, being female compared to male, presence of an acne history, and working hours per day were found to be statistically significant factors. In studies investigating the relationship between mask and facial dermatoses in healthcare personnel during the ongoing COVID-19 period, it has been reported that mask use has caused or exacerbated dermatoses, especially acne, rosacea, seborrheic dermatitis, and contact dermatitis. 4, 9, [19] [20] [21] In a survey conducted in Singapore among healthcare professionals during the severe acute respiratory syndrome (SARS) pandemic period, acne was reported to be the most common facial dermatosis associated with wearing a mask for a long time. 2 In a survey conducted in Thailand with healthcare workers and non-healthcare workers, it was shown that the most common facial dermatosis caused by mask use was acne, and surgical masks caused more skin reactions than cloth masks. 22 In another study, Damian et al., who included 30 patients with acne and 36 with rosacea, reported that both facial dermatoses were triggered after at least 6 weeks of mask use. 23 In the literature, among the studies investigating the relationship between mask use during the COVID-19 pandemic and acne development in healthcare professionals, the highest rate of acne was reported as 62.3% by Aravamuthan and Arumugam, 10 relationship between mask type and mask-related acne and determined a similar incidence of acne between the N95 and surgical mask users (p > 0.005). In the same study, no statistically significant difference was found between the duration of daily mask use and acne development between the participants who developed acne after mask use and those without acne. In our study, N95 was observed to be a risk factor in the development of acne compared to the surgical mask, and this was at a statistically significant level (p = 0.023). The duration of daily mask use was 11 ± 1.1 h for the participants with mask-related acne, which was statistically significantly higher than those without acne (10.5 ± 1.4 h) (p = 0.037). In similar studies, most lesions have been found in areas covered with masks. 19 In the literature, it is recommended to apply non-comedogenic moisturizers before and after mask use, avoid face make-up during acne attacks, use mild cleansers close to the skin's natural pH (pH: 5) , and avoid irritants, such as hot water and ethanol, which disrupt the skin's protective barrier. 28, 29 It is also recommended to wash hands before putting on the mask and after removing it. In order to reduce the amount of water vapor coming out of the mouth and sweating, two layers of gauze should be placed inside the mask. 10 This study had certain limitations. Only medical personnel were included in the study, and therefore, the results do not reflect the situation in the general population. Increasing the number of participants in future or conducting a similar study in the general population may produce different data. Acne presents as the most common facial dermatosis that has increased among healthcare personnel who have had to wear N95 or surgical masks for long hours since the beginning of the pandemic. This is especially observed in those who wear N95 masks and work long hours. All authors have contributed significantly, and all authors are in agreement with the content of the manuscript. There is no conflict of interest among all authors. The study was approved by the Ethics Committee of Istanbul Medipol University. Data sharing not applicable to this article as no datasets were generated or analyzed during the current study. 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Occupational facial dermatoses related to mask use in healthcare professionals