Mask-induced contact dermatitis in handling COVID-19 outbreak

Assessing contact dermatitis risk among Manitoba workers in the Manitoba Occupational Disease Surveillance System

INTRODUCTION

This exploratory study aimed to assess contact dermatitis (CD) risk among workers using the Manitoba Occupational Disease Surveillance System (MODSS).

METHODS

The MODSS linked accepted time-loss claims from the Workers' Compensation Board of Manitoba (2006-2019), with administrative health data from medical and hospital records (1996-2020). CD risk by occupation and industry (hazard ratio, 95% confidence intervals) was estimated using Cox proportional hazard models, adjusted for age and stratified by sex.

RESULTS

Increased risk of new onset CD was observed among some occupations and industries with known skin irritants and allergens. Some occupations with known increased risks of CD remained elevated when removing the accepted WCB cases was performed, suggesting that all CD cases in these occupations may not show up in WCB statistics. Increased risk was also observed for occupations and industries with unknown exposures related to CD, whereas some groups known to be at risk of CD were not observed to have elevated risks in this cohort.

DISCUSSION

The MODSS successfully identified some occupations and industries known to be at high risk of occupational CD, but not others. Some occupations not typically associated with work-related CD were also identified, which warrants further investigation.

New causes of occupational allergic contact dermatitis

PURPOSE OF REVIEW

Occupational allergic contact dermatitis (OACD) is an important work-related skin disease. Information about the causative agents comes from many sources, including patch test databases, registries, case series and case reports. This review summarizes new information about common causative allergens and diagnosis.

RECENT FINDINGS

Common causes of OACD include rubber components, epoxies and preservatives. New exposure sources for these allergens continue to be described. Often these exposure sources are related to the changing world around us, such as allergens related to smartphones and technology, and personal protective equipment-related exposures during the COVID-19 pandemic. New allergens are also being described, some of which are related to known allergens (e.g. a new epoxy or acrylate component).Accurate diagnosis is critical to effective management of OACD, which may include removing the worker from exposure to the causative allergen. Safety data sheets may not contain complete information and patch testing with specialized series of allergens and workplace materials may be necessary.

SUMMARY

This review provides current evidence about causes of OACD and important aspects of diagnosis. This is important for clinical practice to ensure cases of OACD are not missed.

Facial Dermatoses Associated With Mask-Wearing in the COVID-19 Era: A Nationwide, Cross-Sectional, Multicenter, Questionnaire-based Study

BACKGROUND

Daily usage of facial masks during coronavirus disease 2019 pandemic influenced on facial dermatoses.

OBJECTIVE

This study investigated the impact of mask-wearing habits on facial dermatoses.

METHODS

A nationwide, observational, questionnaire-based survey was conducted from July through August 2021, involving 20 hospitals in Korea.

RESULTS

Among 1,958 facial dermatoses, 75.9% of patients experienced aggravation or development of new-onset facial dermatoses after wearing masks. In aggravated or newly developed acne patients (543 out of 743), associated factors were healthcare provider, female gender, and a long duration of mask-wearing. Irritating symptoms, xerosis, and hyperpigmentation were more frequently observed in this group. Aggravated or newly developed rosacea patients (515 out of 660) were likely to be female, young, and have a long duration of mask-wearing per day. Seborrheic dermatitis patients who experienced aggravation or de novo development (132 out of 184) were younger, and they more frequently involved the chin and jaw in addition to the nasolabial folds and both cheeks. Contact dermatitis patients (132 out of 147) with aggravation or de novo development tended to be female, involve both cheeks, and complain of pruritus. Aggravated or newly developed atopic dermatitis patients (165 out of 224) were more likely to be female, and had a higher baseline investigator global assessment score before mask-wearing.

CONCLUSION

Clinical features and factors related to aggravation were different according to the types of facial dermatoses.

Phthalate acid esters contribute to the cytotoxicity of mask leachate: Cell-based assay for toxicity assessment

After the COVID-19 outbreak, masks have become an essential part of people lives. Although several studies have been conducted to determine the release of hazardous substances from masks, how their co-presence poses a potential exposure risk to human health remains unexplored. In this study, we quantitatively compared the leaching of substances from six different common types of masks, including phthalate acid esters (PAEs), metals, and microplastics (MPs), and comprehensively evaluated the potential cytotoxicity of different leachates. MPs smaller than 3 µm were quantified by Py-GC-MS, and reusable masks showed greater releasing potentials up to 1504 µg/g. We also detected the prevalence of PAEs in masks, with the highest release reaching 42 μg/g, with dibutyl phthalate (DBP), diisobutyl phthalate (DiBP) and bis (2-ethylhexyl) phthalate (DEHP) being the predominant types. Moreover, the antimicrobial cloth masks released 173.0 µg of Cu or 4.5 µg of Ag, representing 2.7% and 0.04% of the original masks, respectively. Our cell-based assay results demonstrated for the first time that mask leachate induced nuclear condensation with DNA damage, and simultaneously triggered high levels of glutathione and reactive oxidative stress production, which exacerbated mitochondrial fragmentation, eventually leading to cell death. Combined with substance identification and correlation analysis, PAEs were found to be the contributors to cytotoxicity. Masks containing Cu or Ag led to acidification of lysosomes and alkalinization of cells. These results strongly suggested that the levels of PAEs in the production of regulatory masks should be strictly controlled.

Contact dermatitis caused by prevention measures during the COVID-19 pandemic: a narrative review

Introduction

During the outbreak of Coronavirus disease 2019 (COVID-19), health care workers wore personal protective equipment including masks, gloves and goggles for a long time. In order to reduce the transmission routes of the virus, public places were sprayed with disinfectant. Moreover, the body, hands and clothing were frequently disinfected and washed for hygiene purposes. Studies have shown that these practices could easily irritate the skin and damage the skin barrier. Long-term irritation or exposure to allergens may lead to the occurrence of contact dermatitis (CD).

Methods

Subject headings were searched via the National Library of Medicine (PubMed) and web of science databases: COVID-19; contact dermatitis; adverse skin reaction; PPE; dermatitis; mask; glory; hand hygiene, disinfection; face shield; goggle; protect cloth. A total of 246 and 646 articles were retrieved from the two databases, respectively. 402 articles remained after removing duplicates. Reviews, non-English articles, articles that could not be accessed to read or did not conform to our topic were excluded. Finally, a total of 32 cross-sectional studies, 9 case reports and 2 randomized controlled trials were included.

Discussion

This article reviews reports of CD caused by various prevention and hygiene measures during the COVID-19 pandemic. The amount of skin damage caused by COVID-19 prevention measures could be decreased by improved education about skin management.

Dynamic variation and inhalation exposure of organophosphates esters and phthalic acid esters in face masks

The coronavirus pandemic (COVID-19) has posed a huge global health threat since December 2019. Wearing face masks is known as an effective measure for controlling the wide spread of COVID-19 and its variants. But on the other hand, face masks could be a potential source of organophosphate esters (OPEs) and phthalic acid esters (PAEs) as they are extensively added in masks. However, knowledge associated with the occurrence as well as inhalation risks of OPEs and PAEs in masks is limited. In this study, OPEs and PAEs were determined in different types of mask samples collected from the local market. OPEs and PAEs were detected in mask samples ranging from 36.7 to 855 ng/g, and from 251 to 3830 ng/g, respectively. Relatively lower OPEs and PAEs concentrations were observed in disposable mask for toddlers. Simulated inhalation experiment indicated that the mass loss of OPEs and PAEs was 136 and 3910 ng/mask in disposable masks, 71.9 and 763 ng/mask in disposable mask for toddlers, 924 and 1020 ng/mask in N95 mask after 12 h, respectively. Significantly negative correlations were exhibited between the decrement of OPEs in masks and the increment of OPEs in corresponding polyurethane foams (PUFs) during the course, elucidating OPEs released from masks could be well captured by PUFs. With regard to the variation over time, predominant OPE and PAE analogues showed semblable release and absorption tendency in mask and corresponding PUF. Inhalation exposure risk of OPEs and PAEs was estimated based on the increment of pollutants in PUF. The estimated daily intakes (EDIs), hazard index (HI) and carcinogenic risk (CR) were also calculated and they were within the threshold levels. This study provides the evidence of OPEs and PAEs releasing from the face masks during wearing and unveiled a potential source of OPEs and PAEs exposure to humans.

The face behind the Covid-19 mask - A comprehensive review

The threat of epidemic outbreaks like SARS-CoV-2 is growing owing to the exponential growth of the global population and the continual increase in human mobility. Personal protection against viral infections was enforced using ambient air filters, face masks, and other respiratory protective equipment. Available facemasks feature considerable variation in efficacy, materials usage and characteristic properties. Despite their widespread use and importance, face masks pose major potential threats due to the uncontrolled manufacture and disposal techniques. Improper solid waste management enables viral propagation and increases the volume of associated biomedical waste at an alarming rate. Polymers used in single-use face masks include a spectrum of chemical constituents: plasticisers and flame retardants leading to health-related issues over time. Despite ample research in this field, the efficacy of personal protective equipment and its impact post-disposal is yet to be explored satisfactorily. The following review assimilates information on the different forms of personal protective equipment currently in use. Proper waste management techniques pertaining to such special wastes have also been discussed. The study features a holistic overview of innovations made in face masks and their corresponding impact on human health and environment. Strategies with SDG3 and SDG12, outlining safe and proper disposal of solid waste, have also been discussed. Furthermore, employing the CFD paradigm, a 3D model of a face mask was created based on fluid flow during breathing techniques. Lastly, the review concludes with possible future advancements and promising research avenues in personal protective equipment.

Topical non-pharmacological treatment of eczema: an Italian consensus

Eczematous diseases (contact dermatitis, atopic dermatitis, hand eczema) are among the most frequent findings in dermatological clinical practice. A large body of evidence exists on structural and functional skin barrier damage in eczematous diseases, and on the importance of interventions aimed to repair such damage. While there is substantial agreement on pharmacological treatment, more sparse data are available on role, indications and usefulness of topical non-pharmacological treatments, despite significant research and progress in the composition and technology of emollients, cleansers and barrier creams significantly changed and expanded the functional activities of these products. This often leads to inadequate prescription and/or use, which increase individual and social costs of the disease and make the products useless or, in some cases, even counterproductive. This consensus document, discussed and compiled in a series of meetings by a group of Italian dermatologists experienced in the field of eczematous diseases, summarizes epidemiology and clinical features of the nosological entities of the "eczema family", illustrates the chemical/biochemical structure of emollients, cleansers and barrier creams, and aims to help physicians to exploit the full potential of available products, by providing a detailed but practical guide on characteristics, indications and correct use of non-pharmacological treatments currently available for eczematous diseases.

Dermatite de contact causée par les bandes élastiques d’un masque chirurgical

Les mesures préventives, notamment le port de masques, sont cruciales pour ralentir la transmission de la maladie du COVID-19. Cependant, le port prolongé de masques de protection peut facilement générer une transpiration, une humidité et une friction excessives. Les environnements fermés et chauds augmentent la perméabilité et la sensibilité de la peau aux irritants physiques ou chimiques. Ceci peut entraîner une dermatite de contact irritante cumulative chronique ou même une dermatite de contact allergique. La composition des masques n’est jamais mentionnée sur leur emballage, rendant les investigations allergiques difficiles. Pour minimiser les lésions cutanées, il convient de respecter les normes relatives au port d’équipements de protection et de sécurité.

Skin and respiratory ill-health attributed to occupational face mask use

BACKGROUND

Face mask use in the workplace has become widespread since the onset of the Covid-19 pandemic and has been anecdotally linked to adverse health consequences.

AIMS

To examine reports of adverse health consequences of occupational face mask use received by The Health and Occupation Research (THOR) network before and after the pandemic onset.

METHODS

THOR databases were searched to identify all cases of ill-health attributed to 'face mask' or similar suspected causative agent between 1 January 2010 and 30 June 2021.

RESULTS

Thirty two cases were identified in total, 18 reported by occupational physicians and 14 by dermatologists. Seventy-five per cent of cases were reported after the pandemic onset and 91% cases were in the health and social care sector. 25 of the 35 (71%) diagnoses were dermatological, the most frequent diagnoses being contact dermatitis (14 cases) and folliculitis/acne (6 cases). Of the seven respiratory diagnoses, four were exacerbation of pre-existing asthma.

CONCLUSIONS

There is evidence of an abrupt increase in reports of predominantly dermatological ill-health attributed to occupational face mask use since the start of the pandemic. Respiratory presentations have also occurred.

Facial Dermatoses and Use of Protective Mask During Covid-19 Pandemic: A Clinical and Psychological Evaluation in Patients Affected by Moderate-Severe Atopic Dermatitis Under Treatment With Dupilumab

During the SARS‐COV‐2 pandemic, using face masks became mandatory in many countries. Although evidence suggests that masks can exacerbate several inflammatory skin diseases, few studies focus on their real impact on eczema localized to the face in atopic dermatitis (AD) patients. The aim of this study is to evaluate facial eczema prevalence during pandemic and its psychological impact in AD patients pre‐assessed for systemic treatment and/or in therapy with dupilumab. This study includes 71 patients affected by moderate–severe AD, treated with dupilumab at SCDU of Dermatology in Novara, Italy. We calculated the number of subjects with facial involvement in pre‐ and post‐pandemic periods and the related localization trend. We evaluated, in the two groups, clinical and psychological indicators recorded at each visit and the score modifications during the observational period. No statistically significant differences were observed in facial eczema prevalence, between pre‐ and post‐pandemic periods (p = 0.7618) and in facial eczema remission among the two groups (p = 0.1903). In post‐pandemic period, psychological scores were significantly lower (DLQI and HADS respectively with p < 0.0001 and p = 0.0025) and the reduction in EASI score during observational period was significantly greater (p = 0.0001). Our analysis revealed a potential protective effect of masks on face eczema, suggesting that they could enhance dupilumab efficacy. Face masks, covering sensitive areas, can positively contribute to mental distress in patients with facial eczema, and being associated with a lower allergic diseases incidence may sustain dupilumab in reducing AD severity.

Free formaldehyde in non-medical face masks purchased from the Japanese market since the COVID-19 outbreak

Since the Coronavirus Disease 2019 (COVID-19) pandemic began, people have been wearing face masks for many hours every day. As these face masks are in contact with the skin, it is important to pay more attention to their quality and safety. This study examined the concentration of free formaldehyde in 90 non-medical face masks and related products (33 nonwoven, 30 woven cloth, 12 polyurethane, and 15 related products) because formaldehyde is a common contact allergen in textile products. For products consisting of mixed materials, each material was sampled, resulting in 103 samples for analysis. Free formaldehyde (34-239 μg/g) was found in three cloth masks, which consisted of cotton and polyester, with antibacterial and antiviral labeling. It was confirmed that the detected formaldehyde originated from the mask-finishing treatment by a hydrochloric acid extraction discrimination test. These masks may elicit contact dermatitis if the consumers have already been sensitized to formaldehyde. However, the risk of contact dermatitis caused by formaldehyde in masks may be considered low since the frequency of formaldehyde detection in masks in Japan is low.

Tinea incognito "mask"erading as allergic contact dermatitis due to COVID-19 facial covering in children

We present three children with tinea incognito initially misdiagnosed as allergic contact dermatitis to face masks. All three patients presented with pruritic erythematous patches and plaques across the malar cheek and nose. This case series suggests that clinicians should keep a broad differential when evaluating mask-related facial dermatoses in children.

Novel insights into contact dermatitis

Contact dermatitis is a common disease, caused by repeated skin contact to contact allergens or irritants, resulting in allergic contact dermatitis (ACD) and/or irritant contact dermatitis. Attempts have been made to identify biomarkers to distinguish irritant and allergic patch test reactions, which could aid diagnosis. Some promising candidates have recently been identified, but verification and validation in clinical cases still need to be done. New causes of ACD are constantly recognized. In this review, 10 new contact allergens from recent years, were identified, several relating to anti-age products. Frequent allergens causing considerable morbidity in the population such as the preservative methylisothiazolinone (MI) have been regulated in EU. A significant drop in cases has been seen, while high rates are still occurring in other areas such as North America. Other frequent causes are fragrance allergens especially widely used terpenes and acrylates used in medical devises for control of diabetes. These represent unsolved problems. Recent advances in immunology have opened for a better understanding of the complexity of contact dermatitis, especially ACD. The disease may be more heterogenous that previous understood with several subtypes. With the rapidly evolving molecular understanding of the disease, the potential for development of new drugs for personalized treatment of contact dermatitis is considerable.

Impact in Contact Dermatitis during and after SARS-CoV2 Pandemic

Purpose of the review

Due to the recent COVID-19 pandemic, several skin conditions have emerged due to the preventive measures adopted by both health care workers and the general population against SARS-CoV-2. Above all, wearing of personal protective equipment, frequent hand-washing and disinfecting of surfaces have resulted in an increased risk of irritant or allergic contact dermatitis. The aim of this review is to investigate contact dermatitis associated with COVID-19 pandemic period.

Recent findings

There is a real evidence of the rising prevalence of irritant and allergic contact dermatitis in response to the COVID-19 pandemic. The most commonly recorded symptoms are dryness, itch and redness of the skin. Nasal bridge, cheeks, forehead and hands represent the mainly affected skin sites.

Summary

Contact dermatitis lesions may appear as a result of various recommendations to prevent transmission of COVID-19. Procedures to alleviate pressure and friction, gentle skin care and adequate moisturizing, have been identified as important preventive strategies for contact dermatitis related to personal protective equipment and personal hygiene measures.

Contact dermatitis due to personal protective equipment use and hygiene practices during the COVID-19 pandemic: A systematic review of case reports

BACKGROUND

Prolonged use of personal protective equipment (PPE) may lead to contact dermatitis during the coronavirus disease 19 (COVID-19) pandemic. This paper aims to identify the causative factors of contact dermatitis from PPE and hygiene practices.

METHODS

The search was conducted adhering to PRISMA 2020 guidelines. A Delphi process was employed to ensure that the aims of this study were met. PubMed and Web of Science databases were systematically searched through September 12, 2021, using search terms: Contact dermatitis, case report, covid-19. The findings were tabulated as author/year, gender, age, presentation, cause, dermatological diagnosis, testing modality, provided treatment, symptom resolution (time in days), prognosis, and follow-up.

RESULTS

The mean age of all individuals was 29.75 years, with 75% females. All cases presented with erythema, with 62.5% reporting pruritus and 37.5% reporting burning facial symptoms. Surgical masks and hand-hygiene products (37.5%) were the most commonly reported causative agent with 25% due to KN95/FFP type 2 use. Allergic contact dermatitis (50%) and irritant contact dermatitis (25%) were common diagnoses. Treatments included creams, emollients, and desloratadine, with restriction of irritant-causing factors. The prognosis was generally good among the cases, with 62.5% presenting complete resolution within a week and 12.5% showing moderate improvement at the fourth month after discontinuing use.

CONCLUSION

This study finds pertinent links between PPE use and contact dermatitis during the COVID-19 pandemic. While many cases are bound to go underreported in literature, well-designed, large-scale studies in the future may help promote these associations in a more comprehensive manner.

Face mask-A potential source of phthalate exposure for human

Face masks are necessary for fighting against the coronavirus disease 2019 around the world. As the face mask is usually made from polymers and phthalates are widely-used additives into the polymers, the face mask could be a potential source of phthalate exposure to humans. However, limited knowledge is available on the occurrence and risks of the phthalates from the face mask. In this study, twelve phthalates were determined in 56 mask samples collected from different countries. The phthalates were detected in all the samples with total levels ranging from 115 ng/g to 37,700 ng/g. Estimated daily intakes (EDIs) of the phthalates from the masks ranged from 3.71 to 639 ng/kg-bw/day, and the EDIs of the phthalates from masks for toddlers were approximately 4-5 times higher than those for adults. Non-carcinogenic risks in relation to the phthalates in masks were found to be within safe levels, yet 89.3% of the mask samples exhibited potential carcinogenic effects to humans. The extent of the risks for wearing masks located at a moderate level comparing with other skin-contacted products. This study unveiled a potential source of phthalate exposure to human, and indicated necessity of managing types and levels of additives in the face masks.

Occupational Dermatoses Related to Personal Protective Equipment Used During the COVID-19 Pandemic

The recent coronavirus disease 2019 (COVID-19) pandemic has led to the dramatic increase in use of personal protective equipment (PPE) among health care providers and the general public. Herein the authors discuss the various occupational dermatoses including allergic and irritant contact dermatitis, acne, seborrheic dermatitis, and rosacea related to frequent handwashing, disinfecting of surfaces, and prolonged wear of various PPE including face masks, gloves, and gowns. The authors provide an overview of published PPE-associated occupational dermatoses during the COVID-19 pandemic and also discuss prevention strategies and treatment options to help patients with these complaints.

Occupational Contact Dermatitis: An Individualized Approach to the Worker with Dermatitis

Purpose of Review

To provide an up-to-date, customizable approach to the worker presenting with dermatitis.

Recent Findings

Occupational contact dermatitis (OCD) is often a result of combined allergic, irritant, and endogenous factors. Potential causes of OCD can be categorized in 3 main groupings: workplace materials, personal protective equipment, and skin care. Although patterns of dermatitis may provide some indication of the etiological factor(s), patch testing remains essential in the diagnosis of allergic OCD. Management of OCD may require changes in workplace practices to reduce worker exposure to the causative agents and improve skin care practices.

Summary

OCD is a multifaceted condition with significant consequences for affected workers and their families, employers, and insurers. A methodical and individualized approach to the patient with OCD should ensure timely and accurate diagnosis(es).

Adverse Effects of COVID-19 and Face Masks: A Systematic Review

BACKGROUND

Due to the public health risk associated with SARS-CoV-2 (COVID-19) infection, universal use of face masks has been recommended to protect against viral spread. Adverse facial reactions from the utilization of masks in the general public are poorly characterized in literature.

OBJECTIVE

We aimed to provide a systematic review of studies reporting adverse facial reactions associated with use of face masks during the COVID-19 pandemic.

METHODS

PubMed and Cochrane databases were searched using the following search terms: "masks" AND "skin reactions, facial dermatosis, rash, acne, atopic dermatitis, rosacea, OR seborrheic dermatitis."

METHODS

A total of 954 cases of dermatological adverse effects were reported. Over 17 different adverse facial reactions were found, including the top 10 in order: itch (370, 38.8%), indentation/ear pain (102, 10.7%), discomfort (90, 9.4%), erythema (72, 7.5%), dryness (62, 6.5%), rash (60, 6.3%), scarring (42, 4.4%), desquamation (22, 2.3%), pain (19, 2.0%), burning (19, 2.0%), and wheals (7, 0.7%). Face masks can increase acne (n=44), rosacea (n=14), and seborrheic dermatitis (n=9).

LIMITATIONS

Publication bias of articles, with limited studies available regarding this topic.

CONCLUSION

Wearing face masks to protect from COVID-19 can increase adverse facial dermatoses and exacerbate underlying dermatology conditions; however, several preventative measures may be taken.

The Association of the Prolonged Use of Personal Protective Equipment and Face Mask During COVID-19 Pandemic With Various Dermatologic Disease Manifestations: A Systematic Review

COVID-19 is a novel coronavirus that represents a great global health concern. It is transmitted between individuals through respiratory particles, and as there is no established effective treatment currently for the virus, it is necessary to use protective strategies such as face masks. Healthcare providers and individuals serving outdoors are required to work for long durations wearing personal protective equipment (PPE). Wearing such protective equipment may have short- or long-term effects on the skin health of these individuals. We aim to assess the prevalence and types of dermatological manifestations associated with wearing PPE for a long time during the COVID-19 pandemic period by reviewing the previous studies conducted on this subject. The medical literature, including the databases of PubMed and Google Scholar, from 2019 to 2021 was explored. The search terms included a combination of "Impact of PPE and dermatological outcome," "Wearing PPE for a long time and dermatological manifestations," "Face mask-wearing and dermatological complications," and "Wearing PPE and dermatological manifestations." The inclusion criteria are original full-text articles that reported the association of wearing PPE and dermatological manifestations and outcomes. A total of 70 articles were obtained, among which only 10 articles were eligible for the inclusion criteria. These 10 studies included a total number of 7,643 participants and covered different countries of the world. The extracted data were summarized in a table to facilitate the collection of the important findings. Dermatological complications are frequently reported in people wearing PPE and face masks, especially the ones caused due to PPE among healthcare providers as they tend to use these protective measures for longer durations.

"Face mask dermatitis" due to compulsory facial masks during the SARS-CoV-2 pandemic: data from 550 health care and non-health care workers in Germany

Background

During the COVID-19 pandemic, wearing face masks is mandatory not only for health care workers (HCWs) but also for the general population in many countries around the globe.

Objectives

The aim of the study was to investigate the onset of adverse facial skin reactions due to compulsory face masks during the COVID-19 pandemic in HCWs and non-HCWs, and draw awareness of this new dermatological condition and its preventive measures.

Materials & Methods

A questionnaire was distributed to 550 patients and HCWs from the Department of Dermatology and Allergy of the University Hospital Munich (LMU), Germany. Participants were surveyed regarding mask type, duration of usage and adverse facial skin reactions. Information on symptoms and the use of skin care products and topical drugs were retrieved.

Results

The duration of wearing masks showed a significant impact on the prevalence of symptoms (p < 0.001). Type IV hypersensitivity was significantly more likely in participants with symptoms compared to those without symptoms (p = 0.001), whereas no increase in symptoms was observed in participants with atopic diathesis. HCWs used facial skin care products significantly more often than non-HCWs (p = 0.001).

Conclusion

Preventive and therapeutic measures should be established in order to avoid “face mask dermatitis”, especially for people with underlying risk factors.

What Is New in Occupational Allergic Contact Dermatitis in the Year of the COVID Pandemic?

PURPOSE OF REVIEW

This article aims to summarize some recent trends in occupational allergic contact dermatitis (ACD), including dermatitis related to pandemic-level personal protective equipment in healthcare workers, hazards patients may experience when working from home, and occupational perspectives on the recent American Contact Dermatitis Society (ACDS) allergens of the year and ACDS Core Allergen Series updates.

RECENT FINDINGS

Recent ACDS Allergens of the Year may be particularly relevant to healthcare workers, including isobornyl acrylate, which is present in glucose sensors and propylene glycol present in hand cleansers and disinfectants. Lavender, limonene, and linalool, all of which are new additions to the ACDS Core Allergen Series, have been reported as causes for occupational ACD in massage therapists and aromatherapists. Isothiazolinone allergy continues to rise in both consumer and occupational settings. Finally, the COVID-19 pandemic has resulted in a wave of occupational ACD in healthcare workers to personal protective equipment, and revealed new potential allergens for individuals working from home. Occupational allergic contact dermatitis continues to exert a significant occupational disease burden. Remaining aware of the current trends in allergens may allow for earlier recognition, diagnosis, and treatment, subsequently helping our patients to work in healthier and safer environments.

Prevention and occupational hazards for the skin during COVID-19 pandemic

The life of medical specialists worldwide has dramatically changed due to the spread of the coronavirus disease 2019 (COVID-19) pandemic. Health care professionals (HCPs) have personally faced the outbreak by being on the first line of the battlefield with the disease and, as such, compose a significant number of people who have contracted COVID-19. We propose a classification and discuss the pathophysiology, clinical findings, and treatments and prevention of the occupational skin hazards COVID-19 poses to HCPs. The multivariate pattern of occupational skin diseases during the COVID-19 pandemic can be classified into four subgroups: mechanical skin injury, moisture-associated skin damage, contact reactions, and exacerbation of preexisting dermatoses. The clinical pattern is versatile, and the most affected skin sites were the ones in contact with the protective equipment. Dermatologists should recognize the plethora of HCPs’ occupational skin reactions that are occurring during the COVID-19 pandemic and implement treatment and preventive strategies.

Surface innovation to enhance anti-droplet and hydrophobic behavior of breathable compressed-polyurethane masks

With the emergence of the coronavirus disease (COVID-19), it is essential that face masks demonstrating significant anti-droplet and hydrophobic characteristics are developed and distributed. In this study, a commercial compressed-polyurethane (C-PU) mask was modified by applying a hydrophobic and anti-droplet coating using a silica sol, which was formed by the hydrolysis of tetraethoxysilane (TEOS) under alkaline conditions and hydrolyzed hexadecyltrimethoxysilane (HDTMS) to achieve hydrophobization. The modified mask (C-PU/Si/HDTMS) demonstrated good water repellency resulting in high water contact angle (132°) and low sliding angle (17°). Unmodified and modified masks were characterized using attenuated total reflection-Fourier transform infrared (ATR-FTIR) spectroscopy, scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDS), and X-ray photoelectron spectroscopy (XPS). A drainage test confirmed the strong interaction between the mask surface and coating. Moreover, the coating had negligible effect on the average pore size of the C-PU mask, which retained its high breathability after modification. The application of this coating is a facile approach to impart anti-droplet, hydrophobic, and self-cleaning characteristics to C-PU masks.

Cutaneous Manifestations in Adult Patients with COVID-19 and Dermatologic Conditions Related to the COVID-19 Pandemic in Health Care Workers

PURPOSE OF REVIEW

COVID-19 (coronavirus viral disease 2019), due to the novel SARS-CoV-2, may present with different types of cutaneous manifestations of varying pathophysiology. During the ongoing pandemic, publications reporting dermatologic findings in COVID-19 continue to emerge.

RECENT FINDINGS

Cutaneous vasculopathy and microthrombus-related changes including acral and sacral lesions, retiform purpura, livedo reticularis, and cutaneous vasculitis are notable findings in adult patients. Other exanthems include urticaria or angioedema, morbilliform/maculopapular exanthems, erythema multiforme, and vesicular eruptions. Increased recognition of these findings, especially those consistent with cutaneous microthrombi or vasculitis, is of particular importance. Additionally, occupational dermatologic disease related to extended personal protective equipment (PPE) use, such as skin damage and irritant or allergic contact dermatitis (ACD), represents another emerging problem amidst the pandemic. In this review, we highlight the various cutaneous manifestations associated with COVID-19 in adult patients and occupational dermatitis in health care workers (HCWs) caring for this patient population.