key: cord-0928950-5sg4u514
authors: Giacalone, S.; Minuti, A.; Spigariolo, C.B.; Passoni, E.; Nazzaro, G.
title: Facial dermatoses in general population due to personal protective masks: first observations after lockdown
date: 2020-07-13
journal: Clin Exp Dermatol
DOI: 10.1111/ced.14376
sha: 7658893ff8b623d1a333405af199aabe3a4c43d0
doc_id: 928950
cord_uid: 5sg4u514

Since SARS‐COV‐2 pandemic began, frontline healthcare workers demonstrated to develop facial dermatoses, such as acne, rosacea and seborrheic dermatitis, secondary to prolonged use of personal protective equipment (PPE)

Since SARS-COV-2 pandemic began, frontline healthcare workers demonstrated to develop facial dermatoses, such as acne, rosacea and seborrheic dermatitis, secondary to prolonged use of personal protective equipment (PPE) [1] . Nevertheless, performing a retrospective report of the "emergent" diagnoses during the lockdown period in our Dermatology Unit of Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, we did not observe an increasing number of facial dermatoses among general population [2] . However, on May 4, 2020 Italian Government moved on phase-two of pandemic crisis which allowed people to more freedom in daily life, with the obligation, in most Italian regions, to cover mouth and nose with facial mask. PPE usage time has been widely increased and the first mask-induced facial dermatoses in non-health workers came to our attention.

The first case was a 32-year-old woman which developed a persistent bilateral erythematous rash on her cheeks two weeks after the end of lockdown (Fig.1A ). Anamnesis revealed a previous history of flushing and a usage time of N95 mask for six hours per day because she shared workplace with other two people. We made clinical diagnosis of rosacea and prescribed doxycycline 40 mg for 12 weeks.

A 24-year-old woman was diagnosed for occlusive acne. Clinical examination showed numerous inflamed papules, pustules and microcomedones located on the chin and jaws bilaterally (Fig. 1B) .

She was previously suffering from facial seborrhea but she had never developed similar acne lesions. She worked as barmaid and used facial mask and googles for all eight hours work shift.

Treatment consisted of adapalene 0.1% plus benzoyl peroxide 2.5% gel daily application for eight weeks associated with zinc gluconate 175 mg and nicotinamide 27 mg daily for three months.

The third case involved a 29-year-old man with acute exacerbation of seborrheic dermatitis.

Erythema and greasy scales appeared on the nose, cheeks and beard (Fig 1C) , areas covered by facial mask. He was treated with low-potency steroid cream for five days followed by pimecrolimus 1% ointment daily application for other ten days.

Facial dermatoses are common diseases for dermatologist, however there are some challenging aspects to face with during COVID-19 pandemic. Despite it has been demonstrated that facial protections induce occlusion and consequently a damp and warm microenvironment, responsible of the exacerbation of these conditions [3] , physicians cannot suggest to dismiss PPE; surgical

This article is protected by copyright. All rights reserved mask can be recommended instead of N95 mask, if the work activity allows it. Suggested treatment should include tips about daily skin care, such as application of moisturizers before and after masks utilization. Treating these dermatoses may prevent also COVID-19 contagion, because facial skin damage increases itchy sensation inducing persons to scratch the face and to remove mask [4] , with a reduction of PPE effectiveness.

We think that dermatologists must be aware of the risk of increasing incidence of facial dermatoses among general population, in phase-two, due to occlusive effects of facial PPE.

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