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Li M, Wang F, Tao M, Zhang Y, Pan R, Gu D, Zhong H, Xu Y. N95 respirators alter facial skin physiological functions and lipidome composition in health care personnel. Skin Res Technol 2024; 30:e13653. [PMID: 38488420 PMCID: PMC10941554 DOI: 10.1111/srt.13653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 02/28/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND During the coronavirus disease 2019 pandemic, wearing medical respirators and masks was essential to prevent transmission. OBJECTIVE To quantify the effects of N95 mask usage by measuring facial skin biophysical characteristics and changes in the lipidome. METHODS Sixty healthy volunteers wore N95 respirators for 3 or 6 h. Facial images were acquired and physiological parameters were measured in specific facial areas, before and after mask-wearing. Lipidome analysis was also performed. RESULTS After N95 respirator usage, facial erythema was observed in both the 3 and 6 h groups. Both sebum secretion and trans-epidermal water loss increased significantly in mask-covered cheeks and chins after 6 h of mask wearing compared with before mask wearing (p < 0.05). Principal component analysis revealed significant differences in lipid composition after mask wearing compared with before. The ceramide subclass NS exhibited a positive correlation with stratum corneum hydration, whereas the AP subclass was negatively correlated with trans-epidermal water loss in the 6 h group. CONCLUSION Prolonged wear of N95 respirators may impair facial skin function and alter lipidome composition.
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Affiliation(s)
- Min Li
- Department of DermatologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
- Department of DermatologyFifth People's Hospital of SuzhouSuzhouChina
| | - Feifei Wang
- Yunnan Characteristic Plant Extraction LaboratoryYunnan Yunke Characteristic Plant Extraction Laboratory Co., LtdKunmingChina
- State Key Laboratory of Natural Medicines, School of Traditional Chinese PharmacyChina Pharmaceutical UniversityNanjingChina
| | - Meng Tao
- Department of DermatologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
- Department of DermatologyZigong Fourth People's HospitalZigongChina
| | - Yue Zhang
- Department of DermatologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Ruoxin Pan
- Department of DermatologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Duoduo Gu
- Department of DermatologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Hui Zhong
- State Key Laboratory of Natural Medicines, School of Traditional Chinese PharmacyChina Pharmaceutical UniversityNanjingChina
| | - Yang Xu
- Department of DermatologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
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Tang H, Wang H, Hamblin MR, Jiang L, Zhou Y, Xu Y, Wen X. Contact dermatitis caused by prevention measures during the COVID-19 pandemic: a narrative review. Front Public Health 2023; 11:1189190. [PMID: 37546301 PMCID: PMC10400336 DOI: 10.3389/fpubh.2023.1189190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 07/04/2023] [Indexed: 08/08/2023] Open
Abstract
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.
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Affiliation(s)
- Huimiao Tang
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Hao Wang
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Michael R. Hamblin
- Laser Research Centre, Faculty of Health Science, University of Johannesburg, Doornfontein, South Africa
| | - Lu Jiang
- Outpatient Department of West China Hospital, Sichuan University, Chengdu, China
| | - Yanjun Zhou
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Yidan Xu
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Xiang Wen
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
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3
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Kaur A, Nixon R. Allergic contact dermatitis to mercaptobenzothiazole in N95 mask rubber straps in healthcare workers. Contact Dermatitis 2023. [PMID: 37080922 DOI: 10.1111/cod.14323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 04/22/2023]
Affiliation(s)
- Amreeta Kaur
- Occupational Dermatology Research and Education Centre (ODREC), Skin Health Institute, Carlton, Victoria, Australia
| | - Rosemary Nixon
- Occupational Dermatology Research and Education Centre (ODREC), Skin Health Institute, Carlton, Victoria, Australia
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4
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Kong S, Mawhirt SL. Patch testing results in adult patients with dermatitis during the coronavirus disease 2019 pandemic. Ann Allergy Asthma Immunol 2022; 129:521-522. [PMID: 35858656 PMCID: PMC9288667 DOI: 10.1016/j.anai.2022.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Stephanie Kong
- Department of Medicine, NYU Langone Hospital Long Island, Mineola, New York
| | - Stephanie L Mawhirt
- Department of Medicine, NYU Langone Hospital Long Island, Mineola, New York; NYU Long Island School of Medicine, Mineola, New York.
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5
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Liu N, Ye M, Zhu Q, Chen D, Xu M, He J, Li Q, Li J. Adverse Reactions to Facemasks in Health-Care Workers: A Cross-Sectional Survey. Clin Cosmet Investig Dermatol 2022; 15:947-954. [PMID: 35642175 PMCID: PMC9148581 DOI: 10.2147/ccid.s365390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/17/2022] [Indexed: 11/23/2022]
Abstract
Background Coronavirus disease 2019 (COVID-19) has developed into a worldwide pandemic, which presents several challenges for frontline health-care workers (HCWs). HCWs are highly prone to various skin diseases due to prolonged use of personal protective equipment (PPE). The most frequently used type of PPE is facemasks. To effectively control adverse skin reactions, there is an urgent need for a range of preventive practices. Methods This cross-sectional study was conducted at 12 hospitals in Zhejiang province, China. HCWs were invited to participate in the web survey. Data were extracted by two independent reviewers using a predesigned data collection form and analyzed with SPSS 20.0. Results A total of 1147 questionnaires were collected, and of these, 1090 (95.03%) were valid and returned. The incidence of chest tightness and shortness of breath and face eczema was significantly higher in HCWs wearing N95 facemasks (41.91%; 31.62%) than in the HCWs wearing medical facemasks (38.05%, P = 0.010; 21.91%, P = 0.012). The incidence of ear pain and indentation was significantly higher in HCWs wearing hang-facemasks (83.81%) than in HCWs wearing strains-facemasks (61.19%, P < 0.001). The incidence of ear pain and indentation was significantly higher in HCWs wearing undiscriminating size code facemasks (79.88%) than in the HCWs wearing discriminating size code facemasks (67.86%, P = 0.031). There was a significant reduction (P < 0.001) in the incidence of HCWs without adverse reactions (ADRs) with increasing time wearing facemasks. Conclusion Incidence of ADRs does not significantly increase with the durations of mask wear where wearing mask time exceeded 4 hours per day. The medical staff generally wore masks for more than 4 hours per day; therefore, we recommend taking 15 min of rest after 2 hours of mask-wearing. Results in this study support the conclusion that the type of strain-facemasks and discriminating size code facemasks has a lower incidence of ADRs than other type of medical facemasks.
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Affiliation(s)
- Ning Liu
- Outpatient Department, Zhejiang Rongjun Hospital, Jiaxing, Zhejiang Province, 314000, People's Republic of China
| | - Min Ye
- Nursing Department, Zhejiang Rongjun Hospital, Jiaxing, Zhejiang Province, 314000, People's Republic of China
| | - Qinya Zhu
- Nursing Department, Zhejiang Rongjun Hospital, Jiaxing, Zhejiang Province, 314000, People's Republic of China
| | - Dingchao Chen
- Medical Department, Zhejiang Rongjun Hospital, Jiaxing, Zhejiang Province, 314000, People's Republic of China
| | - Mingmin Xu
- Ultrasonic Department, Zhejiang Rongjun Hospital, Jiaxing, Zhejiang Province, 314000, People's Republic of China
| | - Jia He
- Department of Urology, Zhejiang Rongjun Hospital, Jiaxing, Zhejiang Province, 314000, People's Republic of China
| | - Qian Li
- Ultrasonic Department, Zhejiang Rongjun Hospital, Jiaxing, Zhejiang Province, 314000, People's Republic of China
| | - Jie Li
- The Health Administration Center, Zhejiang Rongjun Hospital, Jiaxing, Zhejiang Province, 314000, People's Republic of China
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6
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Goller M, Dickel H, Nicolay JP. A case of immediate type allergy from polypropylene in a particle filter mask in a nurse. Contact Dermatitis 2022; 87:294-296. [PMID: 35522147 DOI: 10.1111/cod.14143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/25/2022] [Accepted: 05/01/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Mara Goller
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Mannheim, Germany
| | - Heinrich Dickel
- Department of Dermatology, Venereology and Allergology, St. Josef-Hospital, University Medical Center, Ruhr University Bochum, Bochum, Germany
| | - Jan P Nicolay
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Mannheim, Germany
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7
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Kawakami T, Obama T, Sakai S, Takagi M, Takahashi N, Oshima N, Tahara M, Ikarashi Y. Free formaldehyde in non-medical face masks purchased from the Japanese market since the COVID-19 outbreak. JOURNAL OF ENVIRONMENTAL SCIENCE AND HEALTH. PART A, TOXIC/HAZARDOUS SUBSTANCES & ENVIRONMENTAL ENGINEERING 2022; 57:193-197. [PMID: 35240932 DOI: 10.1080/10934529.2022.2047560] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/21/2022] [Accepted: 02/21/2022] [Indexed: 06/14/2023]
Abstract
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.
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Affiliation(s)
- Tsuyoshi Kawakami
- Division of Environmental Chemistry, National Institute of Health Sciences, Kawasaki City, Kanagawa, Japan
| | - Tomoko Obama
- Division of Environmental Chemistry, National Institute of Health Sciences, Kawasaki City, Kanagawa, Japan
| | - Shinobu Sakai
- Division of Environmental Chemistry, National Institute of Health Sciences, Kawasaki City, Kanagawa, Japan
| | - Mihono Takagi
- Division of Environmental Chemistry, National Institute of Health Sciences, Kawasaki City, Kanagawa, Japan
| | - Natsuko Takahashi
- Division of Environmental Chemistry, National Institute of Health Sciences, Kawasaki City, Kanagawa, Japan
| | - Naohiro Oshima
- Division of Environmental Chemistry, National Institute of Health Sciences, Kawasaki City, Kanagawa, Japan
| | - Maiko Tahara
- Division of Environmental Chemistry, National Institute of Health Sciences, Kawasaki City, Kanagawa, Japan
| | - Yoshiaki Ikarashi
- Division of Environmental Chemistry, National Institute of Health Sciences, Kawasaki City, Kanagawa, Japan
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8
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Goossens A, Aerts O. Contact allergy to and allergic contact dermatitis from formaldehyde and -releasers: A clinical review and update. Contact Dermatitis 2022; 87:20-27. [PMID: 35229319 DOI: 10.1111/cod.14089] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 11/29/2022]
Abstract
This review aims to provide a clinically useful update regarding the role of formaldehyde (FA) and its five main releasers (FRs) quaternium-15, diazolidinyl urea, DMDM hydantoin, imidazolidinyl urea and 2-bromo-2-nitropropane-1,3-diol (bronopol) in contact allergy and allergic contact dermatitis. These ubiquitous preservatives are still often, and sometimes undeclared, present in cosmetics, pharmaceuticals, medical devices, household detergents and chemical (industrial) products. In Europe, the use of free FA and quaternium-15 in cosmetics is forbidden and contact allergy rates have been found to be stable to decreasing. However, FA/FRs still readily provoke localized (e.g., facial/hand), airborne and generalized dermatitis, and may also complicate atopic and stasis dermatitis, or result in nummular dermatitis. Seborrheic-, rosacea- and impetigo-like dermatitis have recently been reported. For a correct diagnosis, FA 2% aq. (0.60 mg/cm2 ) should be used, and particularly the FRs bronopol 0.5% pet. and diazolidinyl urea 2% should be patch tested separately in a baseline series. If sensitization to FA occurs, both FA and FRs should preferably be avoided, except perhaps for bronopol in case it tests negatively. If a patient reacts to one or more FRs (such as bronopol, or diazolidinyl/imidazolidinyl urea), but not to FA, then the specific FR(s) should be avoided. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- An Goossens
- Department of Dermatology, University Hospitals KU Leuven, Leuven, Belgium
| | - Olivier Aerts
- Department of Dermatology, University Hospital Antwerp (UZA) and Research group Immunology, INFLA-MED Centre of Excellence, University of Antwerp, Antwerp, Belgium
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Hu B. Recent Advances in Facemask Devices for In Vivo Sampling of Human Exhaled Breath Aerosols and Inhalable Environmental Exposures. Trends Analyt Chem 2022; 151:116600. [PMID: 35310778 PMCID: PMC8917876 DOI: 10.1016/j.trac.2022.116600] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Since the COVID-19 pandemic, the unprecedented use of facemasks has been requiring for wearing in daily life. By wearing facemask, human exhaled breath aerosols and inhaled environmental exposures can be efficiently filtered and thus various filtration residues can be deposited in facemask. Therefore, facemask could be a simple, wearable, in vivo, onsite and noninvasive sampler for collecting exhaled and inhalable compositions, and gain new insights into human health and environmental exposure. In this review, the recent advances in developments and applications of in vivo facemask sampling of human exhaled bacteria, viruses, proteins, and metabolites, and inhalable facemask contaminants and air pollutants, are reviewed. New features of facemask sampling are highlighted. The perspectives and challenges on further development and potential applications of facemask devices are also discussed.
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Affiliation(s)
- Bin Hu
- Institute of Mass Spectrometry and Atmospheric Environment, Guangdong Provincial Engineering Research Center for On-line Source Apportionment System of Air Pollution, Jinan University, Guangzhou 510632, China
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10
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Babino G, Argenziano G, Balato A. Impact in Contact Dermatitis during and after SARS-CoV2 Pandemic. CURRENT TREATMENT OPTIONS IN ALLERGY 2022; 9:19-26. [PMID: 35194543 PMCID: PMC8830973 DOI: 10.1007/s40521-022-00298-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 12/28/2022]
Abstract
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.
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Affiliation(s)
- Graziella Babino
- Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Via Pansini 5, 80131 Naples, Italy
| | - Giuseppe Argenziano
- Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Via Pansini 5, 80131 Naples, Italy
| | - Anna Balato
- Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Via Pansini 5, 80131 Naples, Italy
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11
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Wu P, Li J, Lu X, Tang Y, Cai Z. Release of tens of thousands of microfibers from discarded face masks under simulated environmental conditions. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 806:150458. [PMID: 34592275 PMCID: PMC9752784 DOI: 10.1016/j.scitotenv.2021.150458] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 05/03/2023]
Abstract
While mechanical abrasion by water and sediment is a primary and critical step in weathering process, the upsurge of discarded face masks will undoubtedly become a potential source of micro-/nanofibers owing to the spread of novel coronavirus (COVID-19) pneumonia. However, effects of mechanical abrasion on discarded face masks have neither been seriously addressed nor understood. Therefore, we conducted a simulated experiment to explore abundance, size distribution and morphology of microfibers released from common, surgical and face filtering piece (FFP) masks after mechanical abrasion. Technologies such as Fourier transform infrared spectrometry, fluorescence microscopy, scanning electron microscopy, and confocal laser scanning microscopy were used. Results showed that the abundance of released microfibers followed order of surgical > common > FFP in both water and sediment environments, and the maximum abundance reached 272 ± 12.49 items per square centimeter of mask (items·cm-2) after sediment abrasion. Taking surgical mask for further investigation, the length of released fiber was observed to vary from 47.78 μm to 3.93 mm, and 72.41-89.58% of the total number of released microfibers fell in the range of 0.1-1 mm. However, microfibers with a very small length (1-100 μm) can occupy 0.09-13.59% of the total number of released fibers in sediment environment. The roughness of fiber surface after sediment abrasion was successively increased. Furthermore, the morphology analysis showed significant changes with countless cracks and many prominent protrusions on fiber surface after sediment abrasion. The cracks and protrusions may further accelerate mask decomposition, thereby potentially resulting in the adsorption of other contaminants and the release of self-containing chemicals. This study provides a valuable database of microfibers released from discarded face masks at the primary but critical stage, and further contributes knowledge on environmental impact of discarded personal protective equipment due to COVID-19.
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Affiliation(s)
- Pengfei Wu
- State Environmental Protection Key Laboratory of Integrated Surface Water-Groundwater Pollution Control, School of Environmental Science and Engineering, Southern University of Science and Technology, Shenzhen 518055, PR China; State Key Laboratory of Environmental and Biological Analysis, Department of Chemistry, Hong Kong Baptist University, Hong Kong SAR, PR China.
| | - Jiangpeng Li
- State Environmental Protection Key Laboratory of Integrated Surface Water-Groundwater Pollution Control, School of Environmental Science and Engineering, Southern University of Science and Technology, Shenzhen 518055, PR China; Guangdong Provincial Key Laboratory of Soil and Groundwater Pollution Control, School of Environmental Science and Engineering, Southern University of Science and Technology, Shenzhen 518055, PR China.
| | - Xiao Lu
- State Environmental Protection Key Laboratory of Integrated Surface Water-Groundwater Pollution Control, School of Environmental Science and Engineering, Southern University of Science and Technology, Shenzhen 518055, PR China; Guangdong Provincial Key Laboratory of Soil and Groundwater Pollution Control, School of Environmental Science and Engineering, Southern University of Science and Technology, Shenzhen 518055, PR China.
| | - Yuanyuan Tang
- State Environmental Protection Key Laboratory of Integrated Surface Water-Groundwater Pollution Control, School of Environmental Science and Engineering, Southern University of Science and Technology, Shenzhen 518055, PR China; Guangdong Provincial Key Laboratory of Soil and Groundwater Pollution Control, School of Environmental Science and Engineering, Southern University of Science and Technology, Shenzhen 518055, PR China.
| | - Zongwei Cai
- State Key Laboratory of Environmental and Biological Analysis, Department of Chemistry, Hong Kong Baptist University, Hong Kong SAR, PR China.
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12
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Affiliation(s)
| | - Lora Dagi Glass
- Department of Ophthalmology, Columbia University Medical Center, New York, New York
| | - Pamela L Scheinman
- Department of Dermatology, Brigham and Women's Hospital, Chestnut Hill, Massachusetts.,Dermatology and Skin Care Associates, Wellesley, Massachusetts
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13
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Abdali S, Yu J. Occupational Dermatoses Related to Personal Protective Equipment Used During the COVID-19 Pandemic. Dermatol Clin 2021; 39:555-568. [PMID: 34556245 PMCID: PMC8165076 DOI: 10.1016/j.det.2021.05.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Selli Abdali
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA 19131, USA
| | - JiaDe Yu
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, 50 Staniford St, Boston, MA 02114, USA.
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14
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Jobanputra RD, Hayes J, Royyuru S, Masen MA. A numerical analysis of skin-PPE interaction to prevent facial tissue injury. Sci Rep 2021; 11:16248. [PMID: 34376802 PMCID: PMC8355255 DOI: 10.1038/s41598-021-95861-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/29/2021] [Indexed: 12/02/2022] Open
Abstract
The use of close-fitting PPE is essential to prevent exposure to dispersed airborne matter, including the COVID-19 virus. The current pandemic has increased pressure on healthcare systems around the world, leading to medical professionals using high-grade PPE for prolonged durations, resulting in device-induced skin injuries. This study focuses on computationally improving the interaction between skin and PPE to reduce the likelihood of discomfort and tissue damage. A finite element model is developed to simulate the movement of PPE against the face during day-to-day tasks. Due to limited available data on skin characteristics and how these vary interpersonally between sexes, races and ages, the main objective of this study was to establish the effects and trends that mask modifications have on the resulting subsurface strain energy density distribution in the skin. These modifications include the material, geometric and interfacial properties. Overall, the results show that skin injury can be reduced by using softer mask materials, whilst friction against the skin should be minimised, e.g. through use of micro-textures, humidity control and topical creams. Furthermore, the contact area between the mask and skin should be maximised, whilst the use of soft materials with incompressible behaviour (e.g. many elastomers) should be avoided.
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Affiliation(s)
- Rikeen D Jobanputra
- Tribology Group, Department of Mechanical Engineering, Imperial College London, London, UK.
| | - Jack Hayes
- Tribology Group, Department of Mechanical Engineering, Imperial College London, London, UK
| | - Sravani Royyuru
- Tribology Group, Department of Mechanical Engineering, Imperial College London, London, UK
| | - Marc A Masen
- Tribology Group, Department of Mechanical Engineering, Imperial College London, London, UK
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15
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Damiani G, Gironi LC, Pacifico A, Cristaudo A, Malagoli P, Allocco F, Bragazzi NL, Linder DM, Santus P, Buja A, Savoia P, Pigatto PD. Masks use and facial dermatitis during COVID-19 outbreak: is there a difference between CE and non-CE approved masks? Multi-center, real-life data from a large Italian cohort. Ital J Dermatol Venerol 2021; 156:220-225. [PMID: 33960753 DOI: 10.23736/s2784-8671.21.06895-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND During the recent COVID-19 outbreak, masks became mandatory and shortages frequent, therefore the prevalence of non-CE (European Conformity Mark) approved masks increased in the general population. We aimed to quantify the prevalence of mask-related cutaneous side effects and the differences between CE and non-CE approved masks. METHODS In this multicenter prospective observational study conducted from March 20, 2020 to May 12, 2020(during and after quarantine), patients attending emergency departments for a dermatological consult were clinically assessed and their masks were inspected to detect CE marks and UNI (Italian National Unification Entity) norms. Patients with history of facial dermatoses or under current treatment for facial dermatoses were excluded. RESULTS We enrolled 412 patients (318 during quarantine and 94 after quarantine). CE-approved masks were observed 52.8% vs. 24.5%, whilst subsets of non-CE approved masks were 9.7% vs. 14.9% (Personal protective equipment (PPE)-masks), 16.4% vs. 12.8% (surgical masks [SM]), and 21.1% vs. 47.9%(non-PPE) and (non-SM masks), respectively during and after quarantine. Remarkably, non-CE-approved masks resulted in patients displaying a statistically significant higher incidence of facial dermatoses and irritant contact dermatitis compared to CE-approved masks, and these differences were mainly driven by non-PPE non-SM masks. Comparing quarantine and after quarantine periods, no statistically significant differences were found for CE-approved masks, whilst differences were detected in non-CE-approved masks regarding incidence of facial dermatoses (P<0.0001)and irritant contact dermatitis (P=0.0041). CONCLUSIONS Masks are essential to prevent COVID-19 but at the same time higher awareness regarding mask specifications should be promoted in the general population. Non-PPE and non-SM masks should undergo more rigorous testing to prevent the occurrence of cutaneous side effects and future patients' lawsuit damages.
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Affiliation(s)
- Giovanni Damiani
- Department of Clinical Dermatology, IRCCS Galeazzi Orthopedic Institute, Milan, Italy - .,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy -
| | - Laura C Gironi
- Maggiore della Carità University Hospital, Novara, Italy
| | - Alessia Pacifico
- Department of Clinical Dermatology, IRCCS S. Gallicano Dermatological Institute, Rome, Italy
| | - Antonio Cristaudo
- Department of Clinical Dermatology, IRCCS S. Gallicano Dermatological Institute, Rome, Italy
| | - Piergiorgio Malagoli
- Unit of Dermatology, Hospital of San Donato Milanese, San Donato Milanese, Milan, Italy
| | | | - Nicola L Bragazzi
- Department of Mathematics and Statistics, Laboratory for Industrial and Applied Mathematics (LIAM), York University, Toronto, ON, Canada
| | - Dennis M Linder
- Department of Dermatology, University Hospital, Padua, Italy
| | - Pierachille Santus
- Respiratory Unit, Department of Biomedical And Clinical Sciences (DIBIC), University of Milan, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Alessandra Buja
- Department of Cardiological, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Paola Savoia
- Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Paolo Dm Pigatto
- Department of Clinical Dermatology, IRCCS Galeazzi Orthopedic Institute, Milan, Italy.,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
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Choi SY, Hong JY, Kim HJ, Lee GY, Cheong SH, Jung HJ, Bang CH, Lee DH, Jue MS, Kim HO, Park EJ, Ko JY, Son SW. Mask-induced dermatoses during the COVID-19 pandemic: a questionnaire-based study in 12 Korean hospitals. Clin Exp Dermatol 2021; 46:1504-1510. [PMID: 34081799 PMCID: PMC8239570 DOI: 10.1111/ced.14776] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/20/2021] [Accepted: 05/31/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND During the coronavirus disease 2019 (COVID-19) pandemic, various adverse skin reactions to long-term mask wearing have been reported. AIM To assess the clinical features of mask-induced dermatoses and to recommend prevention and treatment options. METHODS From April to August 2020, questionnaires including topics such as demographic information, pre-existing skin disorders, reported mask-related symptoms, daily mask-wearing duration and frequency, types of masks used and whether the participant was a healthcare worker, were distributed to patients in 12 hospitals. Dermatologists assessed skin lesions, confirmed diagnosis and recorded treatments. RESULTS Itchiness was the most frequent symptom, mostly affecting the cheeks. The most common skin disease was new-onset contact dermatitis (33.94%), followed by new-onset acne (16.97%) and worsening of pre-existing acne (16.97%). Daily wearing of masks was significantly (P = 0.02) associated with new-onset contact dermatitis. More than half of patients with pre-existing skin problems experienced disease worsening while wearing masks. Longer duration of wearing (> 6 h/day, P = 0.04) and use of cotton masks (P < 0.001) significantly increased acne flare-up. Healthcare workers had a higher incidence of skin disease. Skin lesions were generally mild and well tolerated with topical treatment. The study had some limitations: the effect of seasonal characteristics and other risk factors were not assessed, and the patients were visiting dermatological clinics and had interest in their skin status, thus, there may have been selection bias. CONCLUSION Mask-induced/-triggered dermatoses contribute to increase the dermatological burden during the pandemic.
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Affiliation(s)
- S Y Choi
- Department of Dermatology, Ilsan Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - J Y Hong
- Department of Dermatology, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, Korea
| | - H J Kim
- Department of Dermatology, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - G-Y Lee
- Department of Dermatology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - S H Cheong
- Department of Dermatology, Konyang University, Daejeon, Korea
| | - H J Jung
- Department of Dermatology, National Medical Center, Seoul, Korea
| | - C H Bang
- Department of Dermatology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - D H Lee
- Department of Dermatology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - M-S Jue
- Department of Dermatology, Veterans Health Service Medical Center, Seoul, Korea
| | - H O Kim
- Department of Dermatology, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - E J Park
- Department of Dermatology, College of Medicine, Hallym University, Seoul, Korea
| | - J Y Ko
- Department of Dermatology, Hanyang University College of Medicine and Hanyang University Seoul Hospital, Seoul, Korea
| | - S W Son
- Department of Dermatology, Korea University College of Medicine, Seoul, Korea
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17
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"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. Eur J Dermatol 2021; 31:199-204. [PMID: 33814358 PMCID: PMC8356539 DOI: 10.1684/ejd.2021.4007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
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.
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18
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Facial Personal Protective Equipment: Materials, Resterilization Methods, and Management of Occupation-Related Dermatoses. Dermatitis 2021; 32:78-85. [PMID: 33273243 DOI: 10.1097/der.0000000000000699] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The coronavirus infectious disease 2019 pandemic has resulted in health care workers donning personal protective equipment (PPE) for extended periods. OBJECTIVES The aims of the study were to review facial PPE (surgical masks and N95 respirators) ingredients, to identify facial PPE resterilization techniques, and to recommend strategies for prevention and management of facial PPE-related dermatoses. METHODS Twenty-one facial PPE (11 N95 respirators, 10 surgical masks) were reviewed. Resterilization techniques were identified. Personal protective equipment-induced occupational dermatoses and management strategies were explored. RESULTS Polypropylene is the most common chemical identified in facial PPE. Most masks contain aluminum at the nosepiece. Two surgical masks released nickel. Facial PPE dermatoses include irritant contact dermatitis, allergic contact dermatitis, acne, and contact urticaria. Strategies for prevention and management of facial PPE occupational dermatoses are discussed. CONCLUSIONS There are increasing reports of occupational dermatoses associated with facial PPE. This review discusses the components of facial PPE, mask resterilization methods, and strategies for prevention and management of facial PPE dermatoses.
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19
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Lee EB, Lobl M, Ford A, DeLeo V, Adler BL, Wysong A. What Is New in Occupational Allergic Contact Dermatitis in the Year of the COVID Pandemic? Curr Allergy Asthma Rep 2021; 21:26. [PMID: 33779825 PMCID: PMC8006117 DOI: 10.1007/s11882-021-01000-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 12/17/2022]
Abstract
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. Summary 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.
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Affiliation(s)
- Erica B Lee
- Department of Dermatology, University of Nebraska Medical Center, 985645 Nebraska Medical Center, Omaha, NE, 68198-5645, USA
| | - Marissa Lobl
- Department of Dermatology, University of Nebraska Medical Center, 985645 Nebraska Medical Center, Omaha, NE, 68198-5645, USA
| | - Aubree Ford
- Department of Dermatology, University of Nebraska Medical Center, 985645 Nebraska Medical Center, Omaha, NE, 68198-5645, USA
| | - Vincent DeLeo
- Department of Dermatology, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Brandon L Adler
- Department of Dermatology, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Ashley Wysong
- Department of Dermatology, University of Nebraska Medical Center, 985645 Nebraska Medical Center, Omaha, NE, 68198-5645, USA.
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20
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Dowdle TS, Thompson M, Alkul M, Nguyen JM, Sturgeon ALE. COVID-19 and dermatological personal protective equipment considerations. Proc (Bayl Univ Med Cent) 2021; 34:469-472. [PMID: 34219927 DOI: 10.1080/08998280.2021.1899730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Cutaneous injury and irritation among health care workers has substantially risen during the COVID-19 pandemic. In a field already laden with skin-induced injury and irritation due to high levels of handwashing and glove wearing, increases have been reported in handwashing-induced xerosis, irritant dermatitis, and contact dermatitis from N95 respirators and other surgical masks. Masks, goggles, face shields, and gloves all potentially create abrasions from long hours of use, leading to itching, pain, and aggravation of underlying skin conditions. Personal protective equipment (PPE)-related skin injury can be serious, and the American Academy of Dermatology has released recommendations on preventing and treating occupationally induced dermatologic conditions during the COVID-19 pandemic. These are reviewed and discussed in conjunction with overarching guidelines for mitigating the spread of the virus.
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Affiliation(s)
- Travis S Dowdle
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Mallory Thompson
- School of Medicine, Texas Christian University/University of North Texas Health Science Center, Fort Worth, Texas
| | - Mahmud Alkul
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Jeannie M Nguyen
- Department of Dermatology, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Ashley L E Sturgeon
- Department of Dermatology, Texas Tech University Health Sciences Center, Lubbock, Texas
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21
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İnan Doğan E, Kaya F. Dermatological findings in patients admitting to dermatology clinic after using face masks during Covid-19 pandemia: A new health problem. Dermatol Ther 2021; 34:e14934. [PMID: 33751746 PMCID: PMC8206671 DOI: 10.1111/dth.14934] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/29/2020] [Accepted: 03/07/2021] [Indexed: 12/13/2022]
Abstract
In the present study, the purpose was to evaluate the presence of dermatological symptoms and the effects of mask use on existing dermatological diseases associated with face in patients admitting with any dermatological disease. The present study consisted of 150 patients, including 91 volunteering women and 59 men, admitting to our dermatology clinic with any dermatological symptoms. The presence of symptoms, such as itching, rash, drying and peeling, discomfort, redness, burning, pain, swelling, acne, oily skin symptoms because of mask use, and previous history of facial dermatological disease, whether this disease increased with the use of mask, were questioned. The diagnosis made after dermatological examination and the dermatological examination findings were evaluated with the results of the survey. The most common finding in all patients after mask use was itching with a rate of 64.7%. Similar rates were detected for other symptoms. A significant increase was detected in the severity of acneiform and inflammatory dermatosis after the use of masks (P < .05). Our study showed that long-term mask use caused primary skin symptoms, such as itching, redness, rash, dryness and peeling, burning, oily skin, and acne formation in individuals who have dermatological diseases, and also increased the existing dermatological facial diseases. Therefore, it should be recommended to use water-based moisturizers as it may have a barrier effect on the faces of individuals who use a face mask and have any facial dermatosis, and patients should be closely monitored for skin diseases on the face.
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Affiliation(s)
- Esra İnan Doğan
- Department of Dermatovenereology, Adıyaman University School of Medicine Faculty, Adıyaman, Turkey
| | - Ferit Kaya
- Department of Public Health, Adıyaman University School of Medicine Faculty, Adıyaman, Turkey
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22
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23
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Abstract
Background/aim Sars-CoV-2 virus infection (COVID-19) was observed in China in the last months of 2019. In the period following, this infection spread all over the world. In March 2020 the World Health Organization announced the existence of a pandemic. The aim of this manuscript is to investigate skin diseases associated with COVID-19 under three main headings: skin problems related to personal protective equipment and personal hygiene measures, skin findings observed in SARS-CoV-2 virus infections, and skin findings due to COVID-19 treatment agents. Materials and methods In PubMed, Google Scholar databases, skin lesions related to personal protective equipment and personal hygiene measures, skin findings observed in SARS-CoV-2 virus infections and skin findings due to COVID-19 treatment agents subjects are searched in detail. Results Pressure injury, contact dermatitis, itching, pressure urticaria, exacerbation of preexisting skin diseases, and new skin lesion occurrence/new skin disease occurrence may be due to personal protective equipment. Skin problems related to personal hygiene measures could include itching, dryness, and contact dermatitis. Skin findings may also be observed in SARS-CoV-2 virus infections. The incidence of skin lesions due to COVID-19 was reported to be between 0.2% and 29%. Many skin lesions including maculopapular, urticarial, vesicular, chilblain-like, thrombotic/ischemic, etc. are observed in COVID-19 patients. Some authors have stated that there is an absence of SARS-CoV-2 virus infection-specific skin findings. However, in asymptomatic or presymptomatic COVID-19 patients in particular, skin lesions can lead to the diagnosis of COVID-19. In addition, skin lesions may occur due to COVID-19 treatment agents. Conclusion Many skin lesions may appear as a result of COVID-19. Even in the absence of a COVID-19 diagnosis, skin findings should be evaluated carefully in this pandemic period.
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Affiliation(s)
- Ülker GÜL
- Department of Dermatology, Gülhane Faculty of Medicine, Health Sciences University, İstanbulTurkey
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24
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Jefferson T, Del Mar CB, Dooley L, Ferroni E, Al-Ansary LA, Bawazeer GA, van Driel ML, Jones MA, Thorning S, Beller EM, Clark J, Hoffmann TC, Glasziou PP, Conly JM. Physical interventions to interrupt or reduce the spread of respiratory viruses. Cochrane Database Syst Rev 2020; 11:CD006207. [PMID: 33215698 DOI: 10.1101/2020.03.30.20047217] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Viral epidemics or pandemics of acute respiratory infections (ARIs) pose a global threat. Examples are influenza (H1N1) caused by the H1N1pdm09 virus in 2009, severe acute respiratory syndrome (SARS) in 2003, and coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 in 2019. Antiviral drugs and vaccines may be insufficient to prevent their spread. This is an update of a Cochrane Review published in 2007, 2009, 2010, and 2011. The evidence summarised in this review does not include results from studies from the current COVID-19 pandemic. OBJECTIVES To assess the effectiveness of physical interventions to interrupt or reduce the spread of acute respiratory viruses. SEARCH METHODS We searched CENTRAL, PubMed, Embase, CINAHL on 1 April 2020. We searched ClinicalTrials.gov, and the WHO ICTRP on 16 March 2020. We conducted a backwards and forwards citation analysis on the newly included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) and cluster-RCTs of trials investigating physical interventions (screening at entry ports, isolation, quarantine, physical distancing, personal protection, hand hygiene, face masks, and gargling) to prevent respiratory virus transmission. In previous versions of this review we also included observational studies. However, for this update, there were sufficient RCTs to address our study aims. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. We used GRADE to assess the certainty of the evidence. Three pairs of review authors independently extracted data using a standard template applied in previous versions of this review, but which was revised to reflect our focus on RCTs and cluster-RCTs for this update. We did not contact trialists for missing data due to the urgency in completing the review. We extracted data on adverse events (harms) associated with the interventions. MAIN RESULTS We included 44 new RCTs and cluster-RCTs in this update, bringing the total number of randomised trials to 67. There were no included studies conducted during the COVID-19 pandemic. Six ongoing studies were identified, of which three evaluating masks are being conducted concurrent with the COVID pandemic, and one is completed. Many studies were conducted during non-epidemic influenza periods, but several studies were conducted during the global H1N1 influenza pandemic in 2009, and others in epidemic influenza seasons up to 2016. Thus, studies were conducted in the context of lower respiratory viral circulation and transmission compared to COVID-19. The included studies were conducted in heterogeneous settings, ranging from suburban schools to hospital wards in high-income countries; crowded inner city settings in low-income countries; and an immigrant neighbourhood in a high-income country. Compliance with interventions was low in many studies. The risk of bias for the RCTs and cluster-RCTs was mostly high or unclear. Medical/surgical masks compared to no masks We included nine trials (of which eight were cluster-RCTs) comparing medical/surgical masks versus no masks to prevent the spread of viral respiratory illness (two trials with healthcare workers and seven in the community). There is low certainty evidence from nine trials (3507 participants) that wearing a mask may make little or no difference to the outcome of influenza-like illness (ILI) compared to not wearing a mask (risk ratio (RR) 0.99, 95% confidence interval (CI) 0.82 to 1.18. There is moderate certainty evidence that wearing a mask probably makes little or no difference to the outcome of laboratory-confirmed influenza compared to not wearing a mask (RR 0.91, 95% CI 0.66 to 1.26; 6 trials; 3005 participants). Harms were rarely measured and poorly reported. Two studies during COVID-19 plan to recruit a total of 72,000 people. One evaluates medical/surgical masks (N = 6000) (published Annals of Internal Medicine, 18 Nov 2020), and one evaluates cloth masks (N = 66,000). N95/P2 respirators compared to medical/surgical masks We pooled trials comparing N95/P2 respirators with medical/surgical masks (four in healthcare settings and one in a household setting). There is uncertainty over the effects of N95/P2 respirators when compared with medical/surgical masks on the outcomes of clinical respiratory illness (RR 0.70, 95% CI 0.45 to 1.10; very low-certainty evidence; 3 trials; 7779 participants) and ILI (RR 0.82, 95% CI 0.66 to 1.03; low-certainty evidence; 5 trials; 8407 participants). The evidence is limited by imprecision and heterogeneity for these subjective outcomes. The use of a N95/P2 respirator compared to a medical/surgical mask probably makes little or no difference for the objective and more precise outcome of laboratory-confirmed influenza infection (RR 1.10, 95% CI 0.90 to 1.34; moderate-certainty evidence; 5 trials; 8407 participants). Restricting the pooling to healthcare workers made no difference to the overall findings. Harms were poorly measured and reported, but discomfort wearing medical/surgical masks or N95/P2 respirators was mentioned in several studies. One ongoing study recruiting 576 people compares N95/P2 respirators with medical surgical masks for healthcare workers during COVID-19. Hand hygiene compared to control Settings included schools, childcare centres, homes, and offices. In a comparison of hand hygiene interventions with control (no intervention), there was a 16% relative reduction in the number of people with ARIs in the hand hygiene group (RR 0.84, 95% CI 0.82 to 0.86; 7 trials; 44,129 participants; moderate-certainty evidence), suggesting a probable benefit. When considering the more strictly defined outcomes of ILI and laboratory-confirmed influenza, the estimates of effect for ILI (RR 0.98, 95% CI 0.85 to 1.13; 10 trials; 32,641 participants; low-certainty evidence) and laboratory-confirmed influenza (RR 0.91, 95% CI 0.63 to 1.30; 8 trials; 8332 participants; low-certainty evidence) suggest the intervention made little or no difference. We pooled all 16 trials (61,372 participants) for the composite outcome of ARI or ILI or influenza, with each study only contributing once and the most comprehensive outcome reported. The pooled data showed that hand hygiene may offer a benefit with an 11% relative reduction of respiratory illness (RR 0.89, 95% CI 0.84 to 0.95; low-certainty evidence), but with high heterogeneity. Few trials measured and reported harms. There are two ongoing studies of handwashing interventions in 395 children outside of COVID-19. We identified one RCT on quarantine/physical distancing. Company employees in Japan were asked to stay at home if household members had ILI symptoms. Overall fewer people in the intervention group contracted influenza compared with workers in the control group (2.75% versus 3.18%; hazard ratio 0.80, 95% CI 0.66 to 0.97). However, those who stayed at home with their infected family members were 2.17 times more likely to be infected. We found no RCTs on eye protection, gowns and gloves, or screening at entry ports. AUTHORS' CONCLUSIONS The high risk of bias in the trials, variation in outcome measurement, and relatively low compliance with the interventions during the studies hamper drawing firm conclusions and generalising the findings to the current COVID-19 pandemic. There is uncertainty about the effects of face masks. The low-moderate certainty of the evidence means our confidence in the effect estimate is limited, and that the true effect may be different from the observed estimate of the effect. The pooled results of randomised trials did not show a clear reduction in respiratory viral infection with the use of medical/surgical masks during seasonal influenza. There were no clear differences between the use of medical/surgical masks compared with N95/P2 respirators in healthcare workers when used in routine care to reduce respiratory viral infection. Hand hygiene is likely to modestly reduce the burden of respiratory illness. Harms associated with physical interventions were under-investigated. There is a need for large, well-designed RCTs addressing the effectiveness of many of these interventions in multiple settings and populations, especially in those most at risk of ARIs.
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Affiliation(s)
- Tom Jefferson
- Centre for Evidence Based Medicine, University of Oxford, Oxford, UK
| | - Chris B Del Mar
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Liz Dooley
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Eliana Ferroni
- Epidemiological System of the Veneto Region, Regional Center for Epidemiology, Veneto Region, Padova, Italy
| | - Lubna A Al-Ansary
- Department of Family and Community Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ghada A Bawazeer
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Mieke L van Driel
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Mark A Jones
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Sarah Thorning
- GCUH Library, Gold Coast Hospital and Health Service, Southport, Australia
| | - Elaine M Beller
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Tammy C Hoffmann
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Paul P Glasziou
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - John M Conly
- Cumming School of Medicine, University of Calgary, Room AGW5, SSB, Foothills Medical Centre, Calgary, Canada
- O'Brien Institute for Public Health and Synder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Calgary Zone, Alberta Health Services, Calgary, Canada
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25
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Di Altobrando A, La Placa M, Neri I, Piraccini BM, Vincenzi C. Contact dermatitis due to masks and respirators during
COVID
‐19 pandemic: What we should know and what we should do. Dermatol Ther 2020; 33:e14528. [DOI: 10.1111/dth.14528] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/06/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Ambra Di Altobrando
- Department of Experimental, Diagnostic and Specialty Medicine, Division of Dermatology University of Bologna Bologna Italy
| | - Michelangelo La Placa
- Department of Experimental, Diagnostic and Specialty Medicine, Division of Dermatology University of Bologna Bologna Italy
| | - Iria Neri
- Department of Experimental, Diagnostic and Specialty Medicine, Division of Dermatology University of Bologna Bologna Italy
| | - Bianca Maria Piraccini
- Department of Experimental, Diagnostic and Specialty Medicine, Division of Dermatology University of Bologna Bologna Italy
| | - Colombina Vincenzi
- Department of Experimental, Diagnostic and Specialty Medicine, Division of Dermatology University of Bologna Bologna Italy
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Mawhirt SL, Frankel D, Diaz AM. Cutaneous Manifestations in Adult Patients with COVID-19 and Dermatologic Conditions Related to the COVID-19 Pandemic in Health Care Workers. Curr Allergy Asthma Rep 2020; 20:75. [PMID: 33047260 PMCID: PMC7549735 DOI: 10.1007/s11882-020-00974-w] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 01/08/2023]
Abstract
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.
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Affiliation(s)
- Stephanie L Mawhirt
- Division of Allergy and Immunology, Department of Medicine, NYU Winthrop Hospital, 120 Mineola Blvd Suite 410, Mineola, New York, USA.
| | - David Frankel
- Division of Allergy and Immunology, Department of Medicine, NYU Winthrop Hospital, 120 Mineola Blvd Suite 410, Mineola, New York, USA
| | - Althea Marie Diaz
- Department of Medicine, 222 Station Plaza North, Suite 509, Mineola, New York, USA
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27
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Lee HC, Goh CL. 'Occupational dermatoses from Personal Protective Equipment during the COVID-19 pandemic in the tropics - A Review'. J Eur Acad Dermatol Venereol 2020; 35:589-596. [PMID: 32894602 DOI: 10.1111/jdv.16925] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/07/2020] [Accepted: 08/21/2020] [Indexed: 12/18/2022]
Abstract
The COVID-19 pandemic has enveloped the world and there has been a high incidence of occupational dermatoses related to Personal Protective Equipment (PPE) amongst healthcare workers (HCWs) during this period. Prevention and management of these conditions will not only improve staff morale and quality of life, but will also minimize the risk of breaching PPE protocol due to such symptoms. The tropical climate in Singapore predisposes HCWs to more skin damage and pruritus due to intense heat, high humidity and sun exposure. The effects of friction, occlusion, hyperhidrosis and overheating on the skin in the tropics should not be neglected. Preventive measures can be taken based on our recommendations, and the working environment can be made more conducive for frontline HCWs. We review the literature and discuss various preventive and management strategies for these occupational skin diseases for our frontline HCWs, especially those working in less controlled working environments beyond the hospital in Singapore. Shorter shifts and frequent breaks from PPE are recommended. Duration of continuous PPE-usage should not exceed 6 h, with breaks in non-contaminated areas every 2-3 h to hydrate and mitigate the risk of skin reactions. Other strategies, such as teledermatology, should be considered so that consultations can remain accessible, while ensuring the safety and well-being of our clinical staff.
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Affiliation(s)
- H C Lee
- Dermatology Department, KK Women's and Children's Hospital, Singapore
| | - C L Goh
- National Skin Centre, Singapore
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28
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Occupational dermatitis to facial personal protective equipment in health care workers: A systematic review. J Am Acad Dermatol 2020; 84:486-494. [PMID: 33011325 PMCID: PMC7528888 DOI: 10.1016/j.jaad.2020.09.074] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 09/01/2020] [Accepted: 09/23/2020] [Indexed: 01/26/2023]
Abstract
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 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed using PubMed and Embase databases. Articles were included if they reported occupational dermatoses caused by surgical/procedure masks or N95 respirators, or both. Results We identified 344 articles, and 16 were suitable for inclusion in this review. Selected articles focused on facial occupational dermatoses in health care workers. Allergic contact dermatitis to the elastic straps, glue, and formaldehyde released from the mask fabric was reported. 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 (>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. Conclusion 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 health care workers with facial occupational dermatitis.
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29
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Veronese S, Bernardi P, Sbarbati A. How the use of surgical masks during COVID-19 pandemic can induce skin effects. J Eur Acad Dermatol Venereol 2020; 35:e7-e8. [PMID: 32869374 DOI: 10.1111/jdv.16905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- S Veronese
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - P Bernardi
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - A Sbarbati
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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30
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Conly J, Seto WH, Pittet D, Holmes A, Chu M, Hunter PR. Use of medical face masks versus particulate respirators as a component of personal protective equipment for health care workers in the context of the COVID-19 pandemic. Antimicrob Resist Infect Control 2020; 9:126. [PMID: 32762735 PMCID: PMC7406874 DOI: 10.1186/s13756-020-00779-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/09/2020] [Indexed: 12/18/2022] Open
Abstract
Currently available evidence supports that the predominant route of human-to-human transmission of the SARS-CoV-2 is through respiratory droplets and/or contact routes. The report by the World Health Organization (WHO) Joint Mission on Coronavirus Disease 2019 (COVID-19) in China supports person-to-person droplet and fomite transmission during close unprotected contact with the vast majority of the investigated infection clusters occurring within families, with a household secondary attack rate varying between 3 and 10%, a finding that is not consistent with airborne transmission. The reproduction number (R0) for the SARS-CoV-2 is estimated to be between 2.2-2.7, compatible with other respiratory viruses associated with a droplet/contact mode of transmission and very different than an airborne virus like measles with a R0 widely cited to be between 12 and 18. Based on the scientific evidence accumulated to date, our view is that SARS-CoV-2 is not spread by the airborne route to any significant extent and the use of particulate respirators offers no advantage over medical masks as a component of personal protective equipment for the routine care of patients with COVID-19 in the health care setting. Moreover, prolonged use of particulate respirators may result in unintended harms. In conjunction with appropriate hand hygiene, personal protective equipment (PPE) used by health care workers caring for patients with COVID-19 must be used with attention to detail and precision of execution to prevent lapses in adherence and active failures in the donning and doffing of the PPE.
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Affiliation(s)
- John Conly
- University of Calgary and Alberta Health Services, Calgary, Alberta Canada
| | - W. H. Seto
- University of Hong Kong , Hong Kong, China
| | | | - Alison Holmes
- Hopitaux Universitaires de Genève, Geneva, Switzerland
| | - May Chu
- Imperial College, London, United Kingdom
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31
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Gheisari M, Araghi F, Moravvej H, Tabary M, Dadkhahfar S. Skin reactions to non-glove personal protective equipment: an emerging issue in the COVID-19 pandemic. J Eur Acad Dermatol Venereol 2020; 34:e297-e298. [PMID: 32302444 PMCID: PMC7264802 DOI: 10.1111/jdv.16492] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- M Gheisari
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Dermatology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - F Araghi
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - H Moravvej
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Tabary
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - S Dadkhahfar
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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32
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Aerts O, Dendooven E, Foubert K, Stappers S, Ulicki M, Lambert J. Surgical mask dermatitis caused by formaldehyde (releasers) during the
COVID
‐19 pandemic. Contact Dermatitis 2020; 83:172-173. [DOI: 10.1111/cod.13626] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 05/27/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Olivier Aerts
- Department of DermatologyUniversity Hospital Antwerp (UZA) Antwerp Belgium
- Research Group Immunology, Infla‐Med Centre of ExcellenceUniversity of Antwerp Antwerp Belgium
| | - Ella Dendooven
- Department of DermatologyUniversity Hospital Antwerp (UZA) Antwerp Belgium
- Research Group Immunology, Infla‐Med Centre of ExcellenceUniversity of Antwerp Antwerp Belgium
- Research Group Natural Products and Food – Research and Analysis (NatuRA), Department of Pharmaceutical SciencesUniversity of Antwerp (UA) Antwerp Belgium
| | - Kenn Foubert
- Research Group Natural Products and Food – Research and Analysis (NatuRA), Department of Pharmaceutical SciencesUniversity of Antwerp (UA) Antwerp Belgium
| | - Sofie Stappers
- Department of DermatologyUniversity Hospital Antwerp (UZA) Antwerp Belgium
| | - Michal Ulicki
- Department of DermatologyUniversity Hospital Antwerp (UZA) Antwerp Belgium
| | - Julien Lambert
- Department of DermatologyUniversity Hospital Antwerp (UZA) Antwerp Belgium
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33
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Hua W, Zuo Y, Wan R, Xiong L, Tang J, Zou L, Shu X, Li L. Short-term skin reactions following use of N95 respirators and medical masks. Contact Dermatitis 2020; 83:115-121. [PMID: 32406064 PMCID: PMC7272965 DOI: 10.1111/cod.13601] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/09/2020] [Accepted: 05/11/2020] [Indexed: 02/05/2023]
Abstract
Background In the context of the COVID‐19 pandemic, cases of adverse skin reactions related to the wearing of masks have been observed. Objectives To analyze the short‐term effects of N95 respirators and medical masks, respectively, on skin physiological properties and to report adverse skin reactions caused by the protective equipment. Methods This study used a randomized crossover design with repeated measurements. Twenty healthy Chinese volunteers were recruited. Skin parameters were measured on areas covered by the respective masks and on uncovered skin 2 and 4 hours after donning, and 0.5 and 1 hour after removing the masks, including skin hydration, transepidermal water loss (TEWL), erythema, pH, and sebum secretion. Adverse reactions were clinically assessed, and perceived discomfort and non‐compliance measured. Results Skin hydration, TEWL, and pH increased significantly with wearing the protective equipment. Erythema values increased from baseline. Sebum secretion increased both on the covered and uncovered skin with equipment‐wearing. There was no significant difference in physiological values between the two types of equipment. More adverse reactions were reported following a N95 mask use than the use of a medical mask, with a higher score of discomfort and non‐compliance. Conclusions This study demonstrates that skin biophysical characters change as a result of wearing a mask or respirator. N95 respirators were associated with more skin reactions than medical masks.
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Affiliation(s)
- Wei Hua
- Department of Dermatovenereology, West China Hospital, Sichuan University, Chengdu, China.,Cosmetic Safety and Efficacy Evaluation Center of West China Hospital, Sichuan University, Chengdu, China
| | - Ying Zuo
- Department of Dermatovenereology, West China Hospital, Sichuan University, Chengdu, China
| | - Ruoyu Wan
- Department of Dermatovenereology, West China Hospital, Sichuan University, Chengdu, China
| | - Lidan Xiong
- Cosmetic Safety and Efficacy Evaluation Center of West China Hospital, Sichuan University, Chengdu, China
| | - Jie Tang
- Cosmetic Safety and Efficacy Evaluation Center of West China Hospital, Sichuan University, Chengdu, China
| | - Lin Zou
- Cosmetic Safety and Efficacy Evaluation Center of West China Hospital, Sichuan University, Chengdu, China
| | - Xiaohong Shu
- Cosmetic Safety and Efficacy Evaluation Center of West China Hospital, Sichuan University, Chengdu, China
| | - Li Li
- Department of Dermatovenereology, West China Hospital, Sichuan University, Chengdu, China.,Cosmetic Safety and Efficacy Evaluation Center of West China Hospital, Sichuan University, Chengdu, China
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34
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Zuo Y, Hua W, Luo Y, Li L. Skin reactions of N95 masks and medial masks among health-care personnel: A self-report questionnaire survey in China. Contact Dermatitis 2020; 83:145-147. [PMID: 32297349 PMCID: PMC7262031 DOI: 10.1111/cod.13555] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/03/2020] [Accepted: 04/13/2020] [Indexed: 02/05/2023]
Affiliation(s)
- Ying Zuo
- Department of Dermatovenereology, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Hua
- Department of Dermatovenereology, West China Hospital, Sichuan University, Chengdu, China.,Cosmetic Safety and Efficacy Evaluation Center of West China Hospital, Sichuan University, Chengdu, China
| | - Yaxin Luo
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Li Li
- Department of Dermatovenereology, West China Hospital, Sichuan University, Chengdu, China.,Cosmetic Safety and Efficacy Evaluation Center of West China Hospital, Sichuan University, Chengdu, China
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35
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Maliyar K, Sachdeva M, Mufti A, Yeung J. Reply to: "Skin damage among health care workers managing coronavirus disease 2019". J Am Acad Dermatol 2020; 83:e169-e170. [PMID: 32417418 PMCID: PMC7224676 DOI: 10.1016/j.jaad.2020.05.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/05/2020] [Accepted: 05/08/2020] [Indexed: 12/03/2022]
Affiliation(s)
- Khalad Maliyar
- Faculty of Medicine, University of Toronto, Ontario, Canada
| | | | - Asfandyar Mufti
- Department of Dermatology, University of Toronto, Ontario, Canada
| | - Jensen Yeung
- Department of Dermatology, University of Toronto, Ontario, Canada.
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36
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Yan Y, Chen H, Chen L, Cheng B, Diao P, Dong L, Gao X, Gu H, He L, Ji C, Jin H, Lai W, Lei T, Li L, Li L, Li R, Liu D, Liu W, Lu Q, Shi Y, Song J, Tao J, Wang B, Wang G, Wu Y, Xiang L, Xie J, Xu J, Yao Z, Zhang F, Zhang J, Zhong S, Li H, Li H. Consensus of Chinese experts on protection of skin and mucous membrane barrier for health-care workers fighting against coronavirus disease 2019. Dermatol Ther 2020; 33:e13310. [PMID: 32170800 PMCID: PMC7228211 DOI: 10.1111/dth.13310] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 02/05/2023]
Abstract
Health professions preventing and controlling Coronavirus Disease 2019 are prone to skin and mucous membrane injury, which may cause acute and chronic dermatitis, secondary infection and aggravation of underlying skin diseases. This is a consensus of Chinese experts on protective measures and advice on hand‐cleaning‐ and medical‐glove‐related hand protection, mask‐ and goggles‐related face protection, UV‐related protection, eye protection, nasal and oral mucosa protection, outer ear, and hair protection. It is necessary to strictly follow standards of wearing protective equipment and specification of sterilizing and cleaning. Insufficient and excessive protection will have adverse effects on the skin and mucous membrane barrier. At the same time, using moisturizing products is highly recommended to achieve better protection.
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Affiliation(s)
- Yicen Yan
- Department of Dermatology, Peking University First Hospital, National Clinical Research Center for Skin and Immune Diseases, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Xicheng District, Beijing, China
| | - Hui Chen
- Department of Dermatology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Hankou, Wuhan, People's Republic of China
| | - Liuqing Chen
- Department of Dermatology, Wuhan No.1 Hospital, Wuhan, Hubei, People's Republic of China
| | - Bo Cheng
- Department of Dermatology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Ping Diao
- Department of Dermatology, West China Hospital of Sichuan University, Wuhou District, Chengdu City, Sichuan Province, People's Republic of China
| | - Liyun Dong
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China
| | - Xinghua Gao
- Department of Dermatology, Chinese Medical University First Hospital, Shenyang, Liaoning Province, People's Republic of China
| | - Heng Gu
- Hospital for Skin Diseases, Chinese Academy of Medical Sciences, Nanjing, Jiangsu Province, People's Republic of China
| | - Li He
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Wuhua District, Kunming, Yunnan Province, People's Republic of China
| | - Chao Ji
- Department of Dermatology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Hongzhong Jin
- Department of Dermatology, Peking Union Medical College Hospital, Dongcheng District, Beijing, China
| | - Wei Lai
- Department of Dermatology, The Third Affiliated Hospital, Sun Yat-Sen University, Tianhe District, Guangzhou, Guangdong, China
| | - Tiechi Lei
- Department of Dermatology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Li Li
- Department of Dermatology, West China Hospital of Sichuan University, Wuhou District, Chengdu City, Sichuan Province, People's Republic of China
| | - Liuyi Li
- Department of Infection Control, Peking University First Hospital, Xicheng District, Beijing, China
| | - Ruoyu Li
- Department of Dermatology, Peking University First Hospital, National Clinical Research Center for Skin and Immune Diseases, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Xicheng District, Beijing, China
| | - Dongxian Liu
- Department of Dermatology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Hankou, Wuhan, People's Republic of China
| | - Wei Liu
- Department of Dermatology, Air Force General Hospital of PLA, Haidian District, Beijing, People's Republic of China
| | - Qianjin Lu
- Department of Dermatology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ying Shi
- Department of Dermatology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jiquan Song
- Department of Dermatology, Zhongnan Hospital of Wuhan University, Wuchang District, Wuhan, Hubei Province, China
| | - Juan Tao
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China
| | - Baoxi Wang
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Shijingshan District, Beijing, China
| | - Gang Wang
- Department of Dermatology, Xijing Hospital, Air Force Medical University of PLA, Xi'an, Shaanxi, China
| | - Yan Wu
- Department of Dermatology, Peking University First Hospital, National Clinical Research Center for Skin and Immune Diseases, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Xicheng District, Beijing, China
| | - Leihong Xiang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jun Xie
- Department of Dermatology, Zhongnan Hospital of Wuhan University, Wuchang District, Wuhan, Hubei Province, China
| | - Jinhua Xu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhirong Yao
- Department of Dermatology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Yangpu District, Shanghai, People's Republic of China
| | - Furen Zhang
- Shandong Academy of Medical Sciences, Ji'nan, Shandong Province, People's Republic of China
| | - Jianzhong Zhang
- Department of Dermatology, Peking University People's Hospital, Xicheng District, Beijing, People's Republic of China
| | - Shaomin Zhong
- Department of Dermatology, Peking University First Hospital, National Clinical Research Center for Skin and Immune Diseases, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Xicheng District, Beijing, China
| | - Hengjin Li
- Department of Dermatology, Hainan Hospital of PLA General Hospital, Sanya, Hainan Province, China
| | - Hang Li
- Department of Dermatology, Peking University First Hospital, National Clinical Research Center for Skin and Immune Diseases, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Xicheng District, Beijing, China
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37
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Isaksson M, Malinauskiene L. Contact Allergy to Textiles. Contact Dermatitis 2020. [DOI: 10.1007/978-3-319-72451-5_77-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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38
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Alternatives for Allergens in the 2018 American Contact Dermatitis Society Core Series: Report by the American Contact Alternatives Group. Dermatitis 2019; 30:87-105. [DOI: 10.1097/der.0000000000000453] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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39
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Textiles. Contact Dermatitis 2019. [DOI: 10.1007/978-3-319-72451-5_77-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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40
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Mobolaji-Lawal M, Nedorost S. The Role of Textiles in Dermatitis: An Update. Curr Allergy Asthma Rep 2015; 15:17. [PMID: 26130475 DOI: 10.1007/s11882-015-0518-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Dermatitis has important implications for individuals who are affected. It can significantly impair function and quality of life. Dermatitis is multi-factorial and often includes elements of atopic dermatitis, allergic contact dermatitis, and irritant contact dermatitis in a co-existent manner. Textiles are in contact with the human skin for extended periods of time and as a result, they are an important part of the cutaneous environment. Thus, it is not surprising that textiles play a major role in both the etiology and the treatment of various types of dermatitis. This review discusses the role of textiles in dermatitis with an emphasis on interesting and recent advances, trends, perspectives, gaps, and conflicts in the field. In addition, we mention other disease processes to be aware of as they can often mimic textile pattern dermatitis. Lastly, we provide a diagnostic approach for patients presenting with textile pattern dermatitis.
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Affiliation(s)
- Motunrayo Mobolaji-Lawal
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, 9500 Euclid Ave, Cleveland, OH, 44195, USA,
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41
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Hauksson I, Pontén A, Gruvberger B, Isaksson M, Bruze M. Clinically relevant contact allergy to formaldehyde may be missed by testing with formaldehyde 1·0%. Br J Dermatol 2011; 164:568-72. [DOI: 10.1111/j.1365-2133.2010.10151.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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42
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De Groot AC, Le Coz CJ, Lensen GJ, Flyvholm MA, Maibach HI, Coenraads PJ. Formaldehyde-releasers: relationship to formaldehyde contact allergy. Part 2. Formaldehyde-releasers in clothes: durable press chemical finishes. Contact Dermatitis 2010; 63:1-9. [DOI: 10.1111/j.1600-0536.2010.01698.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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43
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de Groot AC, Maibach HI. Does allergic contact dermatitis from formaldehyde in clothes treated with durable-press chemical finishes exist in the USA? Contact Dermatitis 2010; 62:127-36. [DOI: 10.1111/j.1600-0536.2009.01581.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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44
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Won JU. Health Effects of Chemicals used in hospitals among Healthcare Workers. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2010. [DOI: 10.5124/jkma.2010.53.6.474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jong Uk Won
- Department of Preventive Medicine, Yonsei University College of Medicine and Institute for Occupational Health, Korea
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