'Cell-phone acne' epidemic during the COVID-19 pandemic.

As the world continues with the longest and most widespread lockdown in its history, many people are turning towards an increased use of mobile/cell phones as the most convenient way to stay connected. However, this convenience is also taking a toll on patients' overall skin health, particularly in those with acne.

We report on a case group of 13 patients who presented via telemedicine consultations. The study participants comprised healthcare workers and members of the general public during a period of 1 month (1–30 April 2020) who reported new acne eruption or flares of existing acne, mainly involving one side of the face.

Relevant history including duration of use of the phone pressed against the cheek (both before and after lockdown), habit of using cell phone pressed against the cheek during charging, previous history of acne and medications used, were noted. Clinical photographs were obtained, and the total number of lesions including inflammatory and noninflammatory, were counted and grading of severity of acne was done according to the Investigator Global Acne Assessment on Modified Cook's scale.

Of the 13 patients observed, 9 (69.23%; mean age 19.37 ± 3.61 years) had pre‐existing acne, while the remaining 4 (30.77%; mean age 22.07 ± 4.12 years) reported new‐onset acne (Table 1). Grade 3 acne was the most common stage, occurring in six patients (46.15%), while inflammatory lesions (papules, pustules and nodules) were the predominant acne type, occurring in 54.86% (Table 2). All the patients reported increased cell phone use and cell phone–skin contact time during the lockdown period. Interestingly, we observed a unique pattern of acne in these patients. There was a predilection for larger numbers of acne lesions and/or worse disease severity on the side of the face that came in most frequent contact with a cell phone while talking (Table 1, Fig. 1).

Table 1

Demographic and clinical features of study cohort.

Parameter	Result
Patients, n	13
Age, years; mean ± SD	21.71 ± 8.19
Sex, F/M (n)	1.6/1 (8/5)
Pre‐existing acne, n (%)	9 (69.23)
F/M, n (%)	6/3 46.15/23.08
New‐onset acne, n (%)	4 (30.77)
F/M, n (%)	2/2 (15.39/15.39)
Right/left side acne dominance, n (%)	10/3 (76.92/23.08)
Cell phone–skin contact time, h; mean ± SDa
Before lockdown	2.47 ± 2.15
During lockdown	3.39 ± 1.33
Used cell phone while charging, n	8 (53.33)
History of wearing masksb	10 (76.92)

a Information gathered from screen time applications on cell phones;

b N95 or homemade.

Table 2

Grade and type of lesions.

Parameter	Dominant side	Nondominant side	P a
Investigator Global Acne Assessment on Modified Cook scale, n (%)
Grade 0	0	4 (30.77)	0.03b
Grade 1	1 (7.69)	2 (15.39)	0.55
Grade 2	3 (23.08)	4 (30.77)	0.66
Grade 3	6 (46.15)	3 (23.08)	0.23
Grade 4	2 (15.39)	0	0.15
Grade 5	1 (7.69)	0	0.32
Lesion type, n; mean ± SD
Total lesions	23.44 ± 11.12	11.94 ± 5.62	< 0.01b
Inflammatory lesions	19.36 ± 8.61	8.17 ± 4.53	< 0.01b
Noninflammatory lesions	15.93 ± 5.17	13.22 ± 5.87	0.22

a  P value computed by unpaired t‐test or n − 1 χ2 test as appropriate;

b  P ≤ 0.05 was statistically significant.

Figure 1

Acne flare on left side of the face in a left hand‐dominant patient.

The data on eruption of acne or acne flare up due to cell‐phone use are limited. Although a few studies have reported skin rash and a burning sensation due to cell‐phone use, the occurrence of acne has not been specifically reported with it. Unilateral predominance of facial acne was noted by Schwartz, but in that study, it was due to thermogenic aggravation from sources of heat such as sleeping on one side, washing and bathing with hot water, sunbathing, vigorous sports and hot, humid climates.

Taheri et al. proposed that short‐wavelength visible light emitted from smartphones may increase the proliferation of Staphylococcus aureus and thus may induce acne. Along with this theory we speculate that dissipation of heat from the cell phone, friction, trapping of sweat and oil, build‐up of dust and contamination with micro‐organisms, including Staphylococcus may also trigger or flare acne.

To prevent such flares, cell phones should be regularly cleaned. Manufacturer’s recommendations vary, but Apple recommends cleaning with a soft, slightly damp, lint‐free cloth. Care should to be taken that the cell phone should be unplugged and switched off and any cleaning should avoid all openings. Disinfection can be carried out using 70% isopropyl alcohol wipes or bleach‐free disinfectant wipes. Bleach and homemade disinfectants containing substances such as vinegar should be avoided.

Contact with skin can be reduced by rotating sides. Hands‐free, Bluetooth‐enabled devices might be a better choice. Call time should be reduced to prevent phones heating up, and use of phones while charging should be avoided.