key: cord-0941626-4f5frlr5 authors: Yu, Jiade; Chen, Jennifer K.; Mowad, Christen M.; Reeder, Margo; Hylwa, Sara; Chisolm, Sarah; Dunnick, Cory A.; Goldminz, Ari M.; Jacob, Sharon E.; Wu, Peggy A.; Zippin, Jonathan; Atwater, Amber Reck title: Occupational Dermatitis to Facial Personal Protective Equipment in Healthcare Workers: A Systematic Review date: 2020-10-01 journal: J Am Acad Dermatol DOI: 10.1016/j.jaad.2020.09.074 sha: dc228e5715bd660a9165edd756ef4c2d7370c8ca doc_id: 941626 cord_uid: 4f5frlr5 Background Prolonged wear of facial protective equipment can lead to occupational dermatoses. Objective To identify important causes of occupational dermatoses from facial protective equipment. Methods A systematic review following PRISMA guidelines was performed using PubMed and Embase databases. Articles were included if they reported occupational dermatoses caused by surgical/procedure masks and/or N95 respirators. Results 344 articles were identified; 16 were suitable for inclusion in this review. Selected articles focused on facial occupational dermatoses in healthcare workers. Allergic contact dermatitis was reported to the elastic straps, glue, and formaldehyde released from the mask fabric. Irritant contact dermatitis was common on the cheeks and nasal bridge due to pressure and friction. Irritant dermatitis was associated with personal history of atopic dermatitis and prolonged mask wear (greater than 6 hours). Acneiform eruption was reported due to prolonged wear and occlusion. Contact urticaria was rare. Limitations Only publications listed in PubMed or Embase were included. Most publications were case reports and retrospective studies. Conclusions This systematic review from members of the American Contact Dermatitis Society highlights cases of occupational dermatitis to facial protective equipment including potential offending allergens. This work may help in the diagnosis and treatment of healthcare workers with facial occupational dermatitis. Personal protective equipment (PPE), including medical face masks, is essential to the safety of 29 healthcare workers (HCWs). There are two primary types of face masks: surgical/procedure 30 masks and N95 respirators. Surgical/procedure masks (also referred to as medical face masks) 31 are designed to block large-particle droplets and provide varying levels of protection based on 32 the masks' materials. N95 respirators block at least 95% of 0.3-micron test particles. identified. After removal of duplicates and those that did not meet inclusion criteria (Table 1) , 29 49 J o u r n a l P r e -p r o o f areas of involvement in these studies included cheeks, nasal bridge and forehead; these could be 73 potential areas of focus for preventative workplace strategies. HCWs at greater risk for adverse 74 reaction during COVID-19 wore PPE >6 hours/day. 4,5 Length of wear could be a potential 75 workplace modification to assist HCWs experiencing mask-related adverse cutaneous reactions. 76 Two studies on HCWs not in epidemics or pandemics described facial contact dermatitis 6 and 77 facial skin concerns, some of which may have been related to masks. 7 While facial contact 78 dermatitis typically refers to ACD or ICD, it is difficult to conceptualize a diagnosis with the 79 term "skin concern". It would be advantageous if future studies on cutaneous face mask reactions 80 included specific descriptive symptoms and signs. Adhesive chemicals are used in the construction of medical face masks and N95 respirators. A 100 case report described ACD to MDBGN in the adhesive material beneath the mask polyester foam 101 strip. 12 MDBGN is a preservative that is used in some adhesives. Formaldehyde has been described as an allergen in N95 respirators. 13, 14 Formaldehyde is a 104 preservative and is used in the production of resins, plastics, plywood, and paper products. In one 105 case report, chemical evaluation of an N95 respirator identified formaldehyde, possibly a 106 byproduct of polypropylene degradation during production of the mask. 14,15-17 Other potential 107 sources of undisclosed formaldehyde include its presence in raw materials or as a contaminant 108 released from product packaging. 18, 19 Aside from the possible risk of formaldehyde release from 109 polypropylene degradation, polypropylene itself poses a low risk of ACD. identified. After removal of duplicates and those that did not meet inclusion criteria (Table 1) Formaldehyde has been described as an allergen in N95 respirators. 13, 14 Formaldehyde is a 361 preservative and is used in the production of resins, plastics, plywood, and paper products. In one 362 case report, chemical evaluation of an N95 respirator identified formaldehyde, possibly a 363 byproduct of polypropylene degradation during production of the mask. 14,15-17 Other potential J o u r n a l P r e -p r o o f Following Use of N95 Facial Masks Allergic contact dermatitis from formaldehyde textile 200 resins in surgical uniforms and nonwoven textile masks Autoxidation of polyoxyethylenic non-ionic 203 surfactants and of polyethylene glycols Peroxides in polyethylene glycols and polyethylene glycol derivatives Contact allergenic activity of Tween 207 80 before and after air exposure Adverse skin reactions to personal protective 422 equipment against severe acute respiratory syndrome--a descriptive study Occupational contact dermatitis Preferred Reporting Items for Systematic 427 Reviews and Meta-Analyses: The PRISMA Statement Adverse Skin Reactions Among Healthcare Workers During 430 the Coronavirus Disease 2019 Outbreak: A Survey in Wuhan and Its Surrounding 431 Skin damage among health care workers managing 433 coronavirus disease-2019 Self-report occupational-related contact 436 dermatitis: prevalence and risk factors among healthcare workers in Gondar town 2018-a cross-sectional study Safety equipment: When protection 443 becomes a problem Occupational Allergic Contact Dermatitis in an 445 Obstetrics and Gynecology Resident Allergic contact dermatitis in dental professionals: 447 effective diagnosis and treatment A review of non-glove personal 450 protective equipment-related occupational dermatoses reported to EPIDERM between 451 1993 and 2013 Surgical mask contact dermatitis and epidemiology of contact dermatitis Following Use of N95 Facial Masks Allergic contact dermatitis from formaldehyde textile 457 resins in surgical uniforms and nonwoven textile masks Autoxidation of polyoxyethylenic non-ionic 460 surfactants and of polyethylene glycols Peroxides in polyethylene glycols and polyethylene glycol derivatives Contact allergenic activity of Tween 464 80 before and after air exposure