key: cord-0888584-3pw801jw
authors: Gelardi, Matteo; Giancaspro, Rossana; Luperto, Paolo; Cassano, Michele
title: Facial Masks Vestibulitis: The Risk of Mismanagement in the COVID-19 pandemic
date: 2022-01-19
journal: Acta Biomed
DOI: 10.23750/abm.v92i6.11873
sha: 6663a9f7c3bc4fb6cbbaded93af2ded3bdb8f24a
doc_id: 888584
cord_uid: 3pw801jw

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. (www.actabiomedica.it)

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 (1) . Dermatologic 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 (2) . We report the case of a superinfected ICD of the narinal region, characterized by purulent secretions, narinal edema and nasal obstruction.

A 46-year-old Caucasian man with Fitzpatrick skin phototype II complained of nasal vestibule Betamethasone for 10 days. In addition, the patient was advised to better manage the surgical mask, in terms of hygiene and time. The lesions gradually subsided with improvement in nasal obstruction.

As a matter of fact, the prolonged use of facemasks, regardless of the type of mask worn, causes excessive sweating, moisture and friction and creates a microenvironment under the mask which increases skin permeability and sensitivity to physical or chemical factors irritants(3). The most described pathophysiological alterations of the skin are represented by alteration of keratinocytes, release of proinflammatory cytokines, cutaneous microbiota disorders, increased transepidermal water loss (TEWL) and pH (4). These changes can exacerbate pre-existing skin diseases and lead to the onset of ICD or, rarely, ACD. Our patient reported that he had worn the same mask for several days. Moreover, he reported that he often kept the facial mask in his car and did not apply disinfectant sprays. The dermatologist initially treated the nasal lesion with a healing cream. However, due to persistent itching, the patient developed scratching lesions, which played a crucial role in aggravating the culture revealed the presence of Streptococcus agalactiae susceptible to Erhitromicin (MIC(90) ≤ 0,25 microg/ mL). The CBTB showed obstructive edema of narinal region, whereas the remaining morphology of the nasal cavity and paranasal sinuses was normal. He was then diagnosed with facemask-induced ICD and bacterial superinfection. Therefore, the patient was given oral Clarithromycin 500 mg twice daily and a topical preparation containing 0.5% Fusidic Acid and 0.1% situation. In fact, the superinfection by Streptococcus agalactiae probably occurred through contaminated hands. This bacterium frequently colonizes the genitourinary and gastrointestinal tract and causes invasive disease in infants (5) . In this case, the infection had spread from the skin to the subcutaneous tissues causing an obstructive edema of the nostrils.

We believe that the incorrect use of the mask caused the onset of ICD first and subsequently of bacterial superinfection. In this context, in addition to pharmacological therapy, it is essential to raise awareness on the measures to prevent the paradoxical situation in which PPEs become a risk factor for various dermatoses, including changing the mask often, avoiding prolonged use, remove masks for a few minutes in case of heavy sweating and use non-comedogenic emollients before wearing masks (6).

Informed consent: Written informed consent was obtained from the patient for publication of this Case report and any accompanying images.

Effectiveness of personal protective health behaviour against COVID-19

Cutaneous Manifestations in Adult Patients with COVID-19 and Dermatologic Conditions Related to the COVID-19 Pandemic in Health Care Workers

Contact dermatitis due to masks and respirators during COVID-19 pandemic: What we should know and what we should do

Short-term skin reactions following use of N95 respirators and medical masks

Prevalence of group B streptococcal colonization in the healthy non-pregnant population: A systematic review and meta-analysis

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

The authors reported no conflict of interest and no funding has been received for this work.

Each author declares that he or she has no commercial associations (e.g. consultancies, stock ownership, equity interest, patent/licensing arrangement etc.) that might pose a conflict of interest in connection with the submitted article.