Q&A: Protective measures may be needed for skin due to mask-wearing during COVID-19 pandemic
As the world faces the COVID-19 pandemic, wearing a mask or facial covering has been touted as one way to combat the spread of the virus. Most public places, such as grocery stores and essential locations, have now mandated customers and visitors must cover their mouth and nose. Meanwhile, health care providers and those who work in health care facilities have to wear full personal protective equipment, including a mask, for the duration of their shift.
The skin of the face, however, can suffer negative consequences from constant covering. Healio spoke with Heather W. Goff, MD, MPH, associate professor of dermatology and Philip J. Eichhorn Professor of Dermatology at UT Southwestern Medical Center, about how to combat skin problems caused by wearing masks.
Q. Why is it important that individuals follow the directives to wear masks?
A. There are two important reasons. First, it keeps people from touching their face. Secondly, if someone is coughing or sneezing, it provides a guard against spreading droplets to other individuals.
However, if someone is wearing a mask improperly around their chin or over the mouth but not covering the nose, or if they are continually moving it around on their face, it defeats its purpose. It is important for people to bear that in mind.
Q. What effects can constant mask-wearing have on the skin?
A. There has been an uptick in cases of perioral dermatitis relating to mask-wearing. Moisture and vapor, as well as any secretions such as saliva or mucus, are trapped inside the mask. That can act as an irritant dermatitis to the skin and upset the natural balance of the skin around the mouth.
Usually it is going to be rashes, redness, irritation and scaling around the nose and mouth. Sometimes tiny pimples or pustules appear in clusters.
Q. Can you explain how and why this occurs for some people?
A. If you think of a seesaw, the skin is in a state of equilibrium with outside air. Changes in ambient humidity, either too dry or too humid, can trigger perioral dermatitis in an individual who may be predisposed to developing it.
In the case of wearing a mask, it is a little bit tricky because at moments you might be too moist, trapping all this moisture inside the mask. It is almost like diaper dermatitis. But when the skin is in that moist environment and then you take the mask off and let it air out, then sometimes it can be too dry.
I always think of it as when the skin is out of its normal balance. That can be when the skin is moister than it should be or when the skin is getting overly dry and irritated.
Q. What are the best ways to prevent irritated skin caused by wearing a mask?
A. If you are not in health care, avoid wearing masks for extended periods of time. Take your mask off when you do not need to wear it, such as while driving your own car or in the privacy of your own home.
If your skin seems too much on the dry side, you can use a gentle, hypoallergenic moisturizer. It is important not to use something such as witch hazel or rubbing alcohol that will be even more irritating to the skin.
Also, use a neutral cleanser such as Purpose cleanser, Dove unscented soap or Neutrogena face wash to wash your face.
Q. When should someone contact a dermatologist, and what treatment options are there?
A. If someone is doing the first-line preventive measures such as switching to gentle cleansers and hypoallergenic moisturizers and their skin is very dry and raw, you can try a plain coat of something such as Vaseline petroleum jelly. If these things do not work, call your dermatologist and see if they can prescribe you something.
Many dermatologists are doing telehealth appointments now, and in cases of perioral dermatitis, we normally will treat it similarly to rosacea. We will use things such as metronidazole cream or gel topically, which reduces inflammation in the skin. Sometimes we will prescribe very low doses of an antibiotic such as doxycycline.
Q. What can be used for individuals who have to wear a mask for a prolonged amount of time, such as health care workers?
A. A barrier cream such as Desitin Maximum Strength diaper cream can be used. It is an inflammatory and will create a barrier between the skin and the moisture being produced by the mask. It will block out whatever is being created environmentally inside of the mask through chafing, rubbing or humidity. It might seem a little drastic, but you are under a mask anyway, so no one will see or know.
Q. Are there any other issues that can be caused by mask-wearing? And if so, what can be done to combat them?
A. There are a few reported cases of allergic contact dermatitis. This is where someone is allergic to something in the cloth or material the mask is made out of. If you are doing a homemade facial mask, I would recommend washing the fabrics before making them. If you are buying one, wash it before wearing.
A lot of fabric is treated with formaldehyde to keep bugs and insects out while shipping and to maintain the integrity of the fabric in the manufacturing process. But if left in contact with our skin, those things can act as allergens and irritants. – by Rebecca L. Forand
Disclosure: Goff reports no relevant financial disclosures.