key: cord-0888467-8v7nxka5
authors: Kiely, L.F.; O'Connor, C.; O’Briain, G.; O’Briain, C.; Gallagher, J.; Bourke, J.F.
title: Maskne prevalence and associated factors in Irish healthcare workers during the COVID‐19 pandemic
date: 2022-03-16
journal: J Eur Acad Dermatol Venereol
DOI: 10.1111/jdv.18054
sha: 355381d437995b8faa583dea633ee31ee651895f
doc_id: 888467
cord_uid: 8v7nxka5

nan

In early 2020, mask usage was mandated for healthcare workers (HCWs) to limit the transmission of COVID-19. 1, 2 Since then, dermatoses related to personal protective equipment (PPE) have become well-recognized and widely reported, predominantly related to pressure-related damage and irritant contact dermatitis (ICD). 3 A previous Irish study showed that 82% of staff developed ICD, with 26% reporting PPE-related facial dermatoses. 4 We sought to evaluate the prevalence and contributory factors in 'maskne' development amongst Irish HCWs during the COVID-19 pandemic.

In April-May 2021, 700 self-administered questionnaires were distributed to staff in three university hospitals in Cork, Ireland. The questionnaire enquired about history of acne, PPE exposure, maskne development, contributing/alleviating factors and whether advice/treatment was sought.

In total, 337 completed the questionnaire (48% response rate). Most (84.6%, n = 285) were female. Forty-nine per cent were aged between 20 and 30 years, 27.6% between 31 and 40 years and 23.3% were over 40 years. Nursing staff comprised 64.1% of participants, doctors 22%, healthcare assistants (HCAs) 4.7% and allied health professionals 3.9%. Most respondents (72.5%) worked on general wards, 10% on COVID-19 wards, 4.5% in intensive care units and 3.2% in emergency departments.

A quarter (26%, n = 87) had a previous history of acne, and a quarter (25.5%, n = 84) had a family history of acne (first degree relative). The majority were White (82.7%; n = 278) followed by South Asian (7.7%; n = 26), East Asian (3.3%; n = 11) and Black (2.2%; 7). As per the Fitzpatrick scale, most (52.7%) participants reported type I (19.2%, n = 64) or type II (33.5%, n = 112) skin. More darkly pigmented skin types were reported in 47.8% [type III 22.5% (n = 75); type IV 13.8% (n = 46); type V 9.9% (n = 33) and 1.2% (n = 4) type VI].

Over half (53.4%, n = 180) of respondents reported developing maskne since the onset of the COVID-19 pandemic. The majority were (85.5%, n = 154) self-reported papulopustular eruptions, 46% (n = 83) comedonal breakouts and 22.5% (n = 44) nodulocystic lesions. Only 12.8% of HCW with maskne sought medical advice (Fig. 1) .

Factors associated with increased rates of maskne included female gender (OR 4.26; 95% CI 2.11-8.20; P < 0.001), younger age [64.1% of 20-30 year olds compared with 48.8% and 46.7% of the 31-40 and >40 year categories respectively (P = 0.037)], history of acne (OR 2.16 95% CI 1.28-3.64; P = 0.004), family history of acne (OR 1.7 95% CI 1.02-2.89; P = 0.04), working in a 'hot and sweaty' environment (OR 1.89; 95% CI 1.14-3.15; P = 0.014), use of emollients under the masks (OR 1.89; CI 1.21-2.95; P = 0.005) and use of face shields and goggles (OR 1.59; 95% CI 0.97-2.60; P = 0.031; Table 1 ). There was no correlation with duration of mask use (P = 0.097), number of shifts worked per week (P = 0.52), job description (P = 0.793), use of hormonal contraception amongst female staff members (P = 0.474), Fitzpatrick skin type (P = 0.844) or ethnicity (P = 0.22).

Over half of our HCWs developed maskne since the onset of the COVID-19. Our findings suggest that female HCW, younger HCW and those with a personal or family history of acne are at increased risk. The reduction in duration of usage may not prevent maskne, but application of emollients under masks should not be recommended. 5 Limitations of our study include self-reporting of maskne. Our study was vulnerable to responder bias. However, with 55% of the 48% respondents reporting maskne, even if all non-respondents did not develop maskne, the overall prevalence would Figure 1 Prevalence of maskne in this cohort (n = 337), with rates of specific acne subtypes (papulopustular, comedonal and nodulocystic) and advice/treatment-seeking behaviour. 

Coronavirus disease (COVID-19) advice for the public: When and how to use masks

Centers for Disease Control and Prevention Your guide to masks

Occupational dermatoses during the COVID-19 pandemic: a multicentre audit in the UK and Ireland

Irritant contact dermatitis in healthcare workers as a result of the COVID-19 pandemic: a cross-sectional study

Diagnostic and management considerations for "maskne" in the era of COVID-19