Mask-induced facial dermatoses during the COVID-19 pandemic: A cross-sectional study in a tertiary medical center in the Philippines.

To the Editor: Since the start of the COVID-19 pandemic, an increase in the reports of mask-related skin problems was observed. We conducted a cross-sectional study on the prevalence of self-reported, new-onset and/or aggravations of previously diagnosed facial dermatoses among the medical and nonmedical staff of Rizal Medical Center, a tertiary hospital in Pasig, Philippines.

A total of 313 of 319 participants, consisting of medical and nonmedical staff who have been using any type of face mask for at least 6 weeks before the time of study, completed a questionnaire. Of these, 161 (51.4%) respondents had self-reported symptoms of facial dermatoses; the most common reported symptom was itching (n = 126), followed by dryness/tightness of the skin on the area under the mask (n = 66) (Table I). The symptoms of facial dermatosis were only slightly more frequently observed in those using cloth and disposable masks such as surgical, N95, and KN95 masks than in those who wore elastomeric/silicon masks. The type of mask used was not associated with the occurrence of symptoms of facial dermatoses (P = .7079) (Table II).

Table I

Clinical features and other data of the Rizal Medical Center employees using face masks

Variables	Number (n)	Percentage (%)
Number of respondents	313	--
Age (mean, SD)	35.9 ± 8.8
Sex
Female Male	22390	71.228.6
Area of work
Administrative offices Emergency room Outpatient department Operating room/delivery room Ward Others	3448472411149	10.915.315.07.735.515.7
Division
Finance HOPSD MCC Medical Nursing	9151112176	2.84.80.335.856.2

Table II

Type of face masks, duration of wearing, and frequency of face mask use in relation to the development of the symptoms of facial dermatoses

Type, duration and frequency of face mask use	Total	Without symptoms	With symptoms	P value
Type of face mask (% of participants in particular subgroup), n (%)				.7079
Disposable mask Elastomeric/silicon masks Cloth mask	268 (85.6)31 (9.9)14 (4.5)	129 (48.1)17 (54.8)6 (42.9)	139 (51.9)14 (45.2)8 (57.1)
Duration of face masks used per day, n (%)				.6226
8 hours and below 9-16 hours ≥17 hours	66 (21.1)208 (66.5)39 (12.5)	30 (45.5)105 (50.5)17 (43.6)	36 (54.5)103 (49.5)22 (56.4)
Frequency of use, n (%)				.4926
4 days and below 5 days 6 days 7 days	68 (21.8)71 (22.7)25 (8)149 (47.6)	36 (52.9)29 (40.8)13 (52)74 (49.7)	32 (47.1)42 (59.2)12 (48)75 (50.3)

The mean frequency and duration of mask use among the participants was 12.1 hours (SD: ±4.35) and 6 days (SD: ±3.31), respectively. In addition, no significant correlation was found among those who used face masks for 8 hours or more, but many participants reported that their symptoms occurred when they used masks for more than 17 hours. This is consistent with a systematic review published by Barnawi et al, in which the occurrence of dermatological complications from wearing personal protective equipment (PPE) was reported to be more apparent among individuals wearing PPE for more than 4 hours a day. Many participants described symptoms that appeared when they use masks for 5 days a week. In our study, we found no significant difference in frequency and duration of use of different types of masks between respondents with and without symptoms, which is not in concordance with the result of the systematic review on the impact of PPE use on health care workers’ physical health, showing that longer duration of shifts and increased consecutive days of wearing PPE increases the risk of symptom manifestation.

The most common diagnosis of facial dermatoses was acne vulgaris/mechanica (n = 36/78, 46.2%), followed by irritant contact dermatitis (n = 24/78, 30.8%). We found that the symptoms of facial dermatoses significantly differ at a 5% level of significance among those in the medical than in the nonmedical subgroup (Table I). A significant difference was also observed among the different areas of assignment of employees, which could mean that the working environment may be a factor in the occurrence of the symptoms.

Despite emerging reports on the increase in the prevalence of mask-induced facial dermatoses,4, 5 this study showed that the type, frequency, and duration of face mask usage did not significantly correlate with the development of the symptoms of facial dermatosis in many participants. We recommend that further related studies should be conducted with larger sample sizes or data collection should be conducted simultaneously from different institutions and hospitals around the country.

Conflicts of interest

None disclosed.