COVID-19 (also known as SARS-CoV2), a novel coronavirus related to the prior SARS and MERS outbreaks, emerged as a worldwide health threat in winter 2019 and throughout 2020. The current COVID-19 pandemic has caused multiple societal adjustments, including the use of facial masks to enhance social distancing efforts. Although masking is beneficial in terms of controlling the spread of COVID-19, dermatologic effects of masking such as “maskne” (acne and rosacea flare secondary to mask wearing), contact dermatitis and facial infections like impetigo are becoming frequent presenting complaints in the outpatient setting.1 In light of the novelity of this pandemic and masking policies, there are bound to be further unforseen dermatologic consequences associated with mask wearing. In this regard, we report two cases of compromised wound healing related to the wearing of a mask.
The first is a case of wound dehiscence after Mohs micrographic surgery (MMS) and repair of the right lateral zygomatic arch. The patient’s surgery and post-operative course were otherwise uncomplicated. Direct tension by the upper portion of the mask earloop over surgical repair caused delayed partial dehiscence (Figure 1). Given that the surgical site was located on the face, this type of dehiscence could have adversely impacted postoperative scar formation and resulted in an unsatisfactory aesthetic outcome. In practice, prompt intervention resulted in an excellent outcome.
Ideal surgical closure relies on multiple factors, one of which is limiting wound tension with appropriate undermining and well-placed dermal sutures. Other causes of dehiscence include post-operative infection, hematoma formation and tissue necrosis.2 As our patient did not experience any of these latter complications, the dehiscence was deemed to have occurred because of adverse tension with the orientation of the upper ear loop of his COVID-19 protection mask as it lay directly on the area of surgical site that separated. This case of wound dehiscence secondary to tension placed on a healing MMS site due to mask wearing is just one of several experienced by these authors.
The second case relates to impairment of healing after a resurfacing procedure with the fractional ablative laser. A female patient received full-face, fractional carbon dioxide (CO2) resurfacing. She did not experience adverse events during or after the laser procedure. After 8 weeks, the patient returned to the clinic with reticulated, vascular-appearing patches on both posterior cheeks (Figure 2) where the edge of her mask was chafing the skin. This patient healed satisfactorily after appropriate intervention, but the aesthetic outcome of this cosmetic procedure could have been significantly jeopardized by mask wearing.