Mask-Induced Skin Changes Detailed in New Clinical Survey

Nibedita Patro, MD

A new investigation from India detailed a variety of mask-induced skin changes that have occurred throughout the COVID-19 pandemic.

Investigators hoped that this knowledge would help formulate proper precautionary protocols that could promote mask usage for prolonged periods of time.

They added that the pandemic has continued to affect people both physically and mentally, and that continued mask usage – though still recommended- has led to the emergence of various dermatoses including acne, pigmentation, and seborrhea in mask contact areas.

As such, Nibedita Patro, MD, Department of Dermatology at Hi-Tech Hospital in Bhubaneswar, led a team of investigators in a survey study to describe the various skin changes encountered in the medical community who are frequently exposed to prolonged mask use.

The Methods

From June 2021 to August 2021, the team conducted a cross-sectional web-based study at a tertiary care teaching institute. Doctors, interns, resident, and faculty from the institute were asked to participate in the study.

Doctors were required to complete the questionnaire included in the study as well as sign electronic informed consenst.

A total of 178 participants were included in the study ranging from 22-68 years. The male (103) to female (75) ratio was 1.4:1, and a majority of the doctors involved belonged to the 25–35-year-old age group.

The common working setup of participating doctors was the out-patient department (OPD) (69.7%), in-patient department (49.7%), COVID-19 care units (32.6%), casualty (42%), and the intensive care unit (17.7%).

The Findings

There was a significant association (p = 0.009) found between skin changes among doctors using masks for more than 6 hours a day (h/day) (69.7%) as compared to the doctors using masks for less than 6 h/day (30.3%).

Investigators noted that most doctors preferred using the N95 mask (94.9%), the most common of which being the fold flexible model (94.3%). Meanwhile, 41% of doctors used a surgical mask, and 11.2% used cloth masks.

Regarding symptoms, the most common symptom at the site of mask contact was itching in 59 (33.1%) doctors followed by stinging and burning sensation in 22 doctors (12.4%).

Most symptoms appeared between the 1st and 6th month of continuous mask used in 50 participants (61%), and some appeared within 1 month of mask use in 42 doctors (51.2%).

Regarding non-cutaneous symptoms, pain behind the ear (59.6%), discomfort in breathing (52.8%), headache (29.2%), pain in the nose (31.5%), and dizziness (13.5%) were observed.

The most common complaint was increased sweating (55.6%) followed by acne (34.3%) and oily skin (34.3%), though no skin changes were observed in 22.5% of cases.

The use of various cosmeceuticals like sunscreen, moisturizer, and face wash was observed in 24.7%, 27.5%, and 50.6% of participants, respectively. Investigators could not find any significant association between the use of cosmeceuticals and skin change.

“Masks remain an integral part of patient care in hospital settings during this COVID-19 pandemic,” the team wrote. “General awareness of the various mask-induced cutaneous manifestations will help dermatologists in developing future precautionary guidelines regarding the proper use of a mask to prevent skin changes.”

The study, "Mask-induced skin changes during COVID pandemic: A cross-sectional web-based survey among physicians in a tertiary care teaching hospital," was published online in The Journal of Cosmetic Dermatology.