to help exfoliate the surface of the skin and lift away dead skin cells, pore-clogging dirt, oil, and makeup.
• Zinc pidolate, which targets excess oil and further helps clear congested pores
• Grapefruit seed oil, which serves as a natural astringent
Moisturizers for acne prone sensitive skin:
• Avoid comedogenic products
• Include oil free, hypoallergenic products
• Moisturizers rich in ceramides, hyaluronic acid, glycerin, jojoba, marine complex, green tea
• Barrier creams with silicone-related ingredients
• Cosmetics free of dyes, fragrance, lanolin, parabens, and formaldehyde • Moisturizer with minerals and ingredients that stabilize microbiota of the skin with prebiotic thermal water, selenium • Topical pre and postbiotic, including prebiotic oat extract
Prescription treatment:
• Avoid high strength retinoid acids such as tazarotene, high percentage tretinoin; use low potency retinoic acid such as adapalene once or twice a week if needed. Newer versions of retinoids in lotion form can be used as alternatives.
• Azelaic acid 15% gel or foam two times a day will help with acne and post-inflammatory hyperpigmentation • Mandelic acid 5% pads, improves acne and post-inflammatory hyperpigmentation
• Erythromycin ointment will help with inflammatory papules and irritation of the skin
• Avoid antibiotic solutions with alcohol
• Minocycline foam formulation which contains coconut oil in the vehicle and helps with moisturization. • Oral antibiotics if patients present with moderate to severe acne
In cases of Isotretinoin treatment, utilize non-comedogenic moisturizers and the use of emollients before applying the mask.
The use of hydrocolloid bandages is practical for inflammatory papules and to prevent picking at certain lesions. These bandages absorb excess fluid, (ie, oil and pus) and can speed healing time for excoriated inflammatory lesions. They can help prevent scarring and post-inflammatory hyperpigmentation. This bandage can be left on for a few hours and have ingredients such as salicylic and hyaluronic acids.
II. Allergic Dermatitis, Contact Dermatitis, and Postinflammatory Hyperpigmentation
The aforementioned lesions include abrasions, pressure ulcers, edema, crusts, long term erythema and acne and folliculitis. Important consideration should be given to the possibility of some patients developing an irritant contact dermatitis secondary to the equipment. True allergic contact dermatitis may occur to adhesives, rubber, or metal used in the masks. Patch testing may be prudent in those cases. The N95 masks are made of polypropylene fabric, a nonwoven technology.
Postinflammatory hyperpigmentation is mainly caused by pressure-related effects of mask use, especially on bony protrusions. Due to the long-term inflammatory reaction generated by the pressure changes in the affected tissues, melanocytes increase their melanin production and a localized brown patch can appear days after the initial signs of inflammation (ie. edema and erythema). This adverse effect can affect all skin phototypes, particularly Fitzpatrick skin types III, IV, and V.
Early implementation of emollients and topical corticosteroids in patients suspected of having contact dermatitis is useful for alleviating pruritus. For post-inflammatory hyperpigmentation, consider the use of azelaic acid, retinol, and other treatment options including short term hydroquinone in combination with fluocinonide 0.05% cream once the active lesions have cleared.
• Zinc pidolate, which targets excess oil and further helps clear congested pores
• Grapefruit seed oil, which serves as a natural astringent
Moisturizers for acne prone sensitive skin:
• Avoid comedogenic products
• Include oil free, hypoallergenic products
• Moisturizers rich in ceramides, hyaluronic acid, glycerin, jojoba, marine complex, green tea
• Barrier creams with silicone-related ingredients
• Cosmetics free of dyes, fragrance, lanolin, parabens, and formaldehyde • Moisturizer with minerals and ingredients that stabilize microbiota of the skin with prebiotic thermal water, selenium • Topical pre and postbiotic, including prebiotic oat extract
Prescription treatment:
• Avoid high strength retinoid acids such as tazarotene, high percentage tretinoin; use low potency retinoic acid such as adapalene once or twice a week if needed. Newer versions of retinoids in lotion form can be used as alternatives.
• Azelaic acid 15% gel or foam two times a day will help with acne and post-inflammatory hyperpigmentation • Mandelic acid 5% pads, improves acne and post-inflammatory hyperpigmentation
• Erythromycin ointment will help with inflammatory papules and irritation of the skin
• Avoid antibiotic solutions with alcohol
• Minocycline foam formulation which contains coconut oil in the vehicle and helps with moisturization. • Oral antibiotics if patients present with moderate to severe acne
In cases of Isotretinoin treatment, utilize non-comedogenic moisturizers and the use of emollients before applying the mask.
The use of hydrocolloid bandages is practical for inflammatory papules and to prevent picking at certain lesions. These bandages absorb excess fluid, (ie, oil and pus) and can speed healing time for excoriated inflammatory lesions. They can help prevent scarring and post-inflammatory hyperpigmentation. This bandage can be left on for a few hours and have ingredients such as salicylic and hyaluronic acids.
II. Allergic Dermatitis, Contact Dermatitis, and Postinflammatory Hyperpigmentation
The aforementioned lesions include abrasions, pressure ulcers, edema, crusts, long term erythema and acne and folliculitis. Important consideration should be given to the possibility of some patients developing an irritant contact dermatitis secondary to the equipment. True allergic contact dermatitis may occur to adhesives, rubber, or metal used in the masks. Patch testing may be prudent in those cases. The N95 masks are made of polypropylene fabric, a nonwoven technology.
Postinflammatory hyperpigmentation is mainly caused by pressure-related effects of mask use, especially on bony protrusions. Due to the long-term inflammatory reaction generated by the pressure changes in the affected tissues, melanocytes increase their melanin production and a localized brown patch can appear days after the initial signs of inflammation (ie. edema and erythema). This adverse effect can affect all skin phototypes, particularly Fitzpatrick skin types III, IV, and V.
Early implementation of emollients and topical corticosteroids in patients suspected of having contact dermatitis is useful for alleviating pruritus. For post-inflammatory hyperpigmentation, consider the use of azelaic acid, retinol, and other treatment options including short term hydroquinone in combination with fluocinonide 0.05% cream once the active lesions have cleared.
CONCLUSION
In general, when evaluating frontline healthcare workers with skin lesions, the clinical assessment as well as a full review of symptoms may be of guidance towards the correct treatment and resolution of the chief complaint. Prevention is key for the use of PPE during this pandemic, as well as any future instances that require N95 respirators on a daily basis.
This article reviews current reported facial lesions secondary to daily mask use seen in frontline healthcare workers working against COVID-19. When patients and providers have an astute understanding of this novel virus, it’s replicative nature, the dire need for PPE for those treating affected patients, and the short and long term effects of PPE on the skin barrier, we are able to elucidate a wide variety of treatments and recommendations to prevent long term effects on the skin. This is an ongoing and rapidly developing situation that as dermatologists we will continue to investigate and report any new lesions developed by the frontlines health workers. By imparting these therapies to the general public as well as to physicians treating COVID-19 skin conditions, we aim to provide comprehensive and effective recommendations in maintaining proper skin barrier protection, a crucial component of containing this virus.
This article reviews current reported facial lesions secondary to daily mask use seen in frontline healthcare workers working against COVID-19. When patients and providers have an astute understanding of this novel virus, it’s replicative nature, the dire need for PPE for those treating affected patients, and the short and long term effects of PPE on the skin barrier, we are able to elucidate a wide variety of treatments and recommendations to prevent long term effects on the skin. This is an ongoing and rapidly developing situation that as dermatologists we will continue to investigate and report any new lesions developed by the frontlines health workers. By imparting these therapies to the general public as well as to physicians treating COVID-19 skin conditions, we aim to provide comprehensive and effective recommendations in maintaining proper skin barrier protection, a crucial component of containing this virus.
DISCLOSURES
None of the other authors listed have any commercial associations or financial disclosures that might pose or create a conflict of interest with the methods applied or the results presented.
REFERENCES
1. ZhuN, Zhang D, Wang W, et al. China Novel Coronavirus Investigating and
