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About half of people who wear face masks may develop acne, facial dermatitis, itching or pressure sores, and the risk increases with the length of time the mask is worn, according to a systematic review and meta-analysis recently published.
“This report reveals that the most statistically significant risk factor for developing facial dermatosis under a face mask is the duration of mask wear. Specifically, wearing a mask for more than 4-6 hours is most strongly correlated with the development of a facial skin problem,” said Jami L. Miller, MD, associate professor of dermatology, Vanderbilt University Medical Center, Nashville, Tennessee, Medscape Medical News. Miller was not involved in the study.
“The type of mask and the environment mattered less,” she added.
Mask-wearing for infection control has been common during the COVID-19 pandemic and will likely continue for some time, study co-authors Lim Yi Shen Justin, MBBS, and Yik Weng Yu, MBBS, MPH, PhD , Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, wrote in an email to Medscape Medical News. And cross-sectional studies have suggested a link between mask wearing and various facial dermatoses.
To assess this link as well as potential risk factors for facial dermatoses, researchers reviewed 37 studies published between 2004 and 2022 involving 29,557 adult participants who reported regularly using any type of face mask, across 17 countries in Europe and Asia. . (Types of masks commonly studied in the articles they analyzed included surgical masks and respirators.)
Facial dermatoses were self-reported in 30 studies (81.1%) and were diagnosed by trained dermatologists in seven studies (18.9%).
Justin and Yu discovered that:
The overall prevalence of facial dermatoses was 55%
Individually, facial dermatitis, itching, acne, and pressure injuries were consistently reported as facial dermatoses, with combined prevalence rates of 24%, 30%, 31%, and 31%, respectively.
Duration of mask wearing was the strongest risk factor for facial dermatoses (P
Respirators, including N95 masks, were no more likely than surgical masks to be linked to facial dermatoses
“Understanding the risk factors of mask wearing, including location, duration and type of mask, can enable targeted interventions to mitigate issues,” Yu said.
He advised taking a break from wearing the mask after 4-6 hours to improve results.
Yew acknowledged the limitations, including the fact that most of the studies reviewed relied on self-reported symptoms.
“Patient factors were not investigated in most studies, therefore, we were unable to determine their contributory role in the development of mask-wearing facial dermatoses,” he said. declared. “We were also unable to prove the causal link between risk factors and outcomes.”
Four dermatologists hail the results
Miller called it an “interesting and certainly relevant” study, now that mask-wearing is common and facial skin problems are fairly common complaints at doctor’s visits.
“As the authors say, contact irritants or allergens with longer exposures can be expected to cause more severe dermatitis than short contact,” she said. “A longer duration can also cause clogging of pores and hair follicles, which can worsen acne and folliculitis.”
“I was surprised that the type of mask didn’t seem to matter significantly,” she added. “Patients wearing N95 masks can be relieved to know that N95s cause no more skin problems than lighter masks.”
Still, Miller had several questions, including whether materials and chemical finishes that vary by manufacturer can affect skin conditions.
Olga Bunimovich, MD, assistant professor, department of dermatology, University of Pittsburgh School of Medicine, Pennsylvania, called this study “an excellent step toward characterizing the role masks play in facial dermatoses.”
“The study provides a window into the prevalence of these conditions as well as some understanding of the factors that may contribute to them,” added Bunimovich, who was not part of the study. But “we can also use this information to modify behavior in the work environment, enabling ‘mask-free’ breaks to reduce the risk of facial dermatoses.”
Elma Baron, MD, professor and director, Skin Study Center, Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio, expected the skin problems to be related to mask wearing, but didn’t didn’t expect the prevalence to be as high as 55%, which she called “very significant.”
“Mask wearing is an important way to prevent the transmission of communicable infections, and this practice will most likely continue,” she said.
“Given the data, it is reasonable to advise patients already prone to these specific dermatoses to be proactive,” she added. “Early intervention with appropriate topical medications, preferably prescribed by a dermatologist or other healthcare professional, and frequent changing of face masks before they become wet, will hopefully reduce the severity of rashes and minimize the negative impact on quality of life.”
Commenting on Justin and Yu’s study, Susan Massick, MD, dermatologist and clinical associate professor of internal medicine, The Ohio State University Wexner Medical Center, Westerville, said Medscape Medical News that she urges people to wear masks, despite these risks.
“The majority of concerns are simple, manageable and overall benign,” she said. “We have a multitude of treatments that can help control, treat or improve symptoms.”
“Masks are an effective and easy way to protect against infection and they remain one of the most reliable preventions we have,” Massick noted. “The results of this article shouldn’t stop anyone from wearing a mask, nor should facial dermatoses be a reason for people to stop wearing their masks.”
Contact dermatitis. Published online August 18, 2022. Summary
The study received no funding. The authors, as well as Baron, Miller, Bunimovich, and Massick, who were not involved in the study, reported no relevant financial relationships. All experts commented by email.
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