Face mask induced dermatological problems in healthcare providers during COVID-19 pandemic: A questionnaire based study

Ganiger Veena, Nagesha C. Parvathi, Rangaswamy H. Umadevi, Nirvanappa K. Vinay, Ittigi Vivekananda

Department of Dermatology Venereology and Leprosy, Hassan Institute of Medical Sciences, Hassan, Karnataka, India

Corresponding author: Nagesha C. Parvathi, MD

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Submission: 25.10.2021; Acceptance: 17.02.2022

DOI: 10.7241/ourd.2022e.16

Cite this article: Veena G, Parvathi CN, Umadevi HR, Vinay HR, Vivekananda I. Face mask induced dermatological problems in healthcare providers during COVID-19 pandemic: A questionnaire based study. Our Dermatol Online. 2022;13(e):e16.

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© Our Dermatology Online 2022. No commercial re-use. See rights and permissions. Published by Our Dermatology Online.

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ABSTRACT

Background: Facemasks plays essential role in present corona virus (SARS-CoV-2) pandemic situation. Facemasks usage is mandatory and unavoidable for both the general population and the hospital staff. Aquestionnaire based study was undertaken to evaluate the facemask induced dermatological problems during the COVID-19 pandemic in health care providers.

Methods: The study was conducted on health care providers, in a tertiary care hospital. Data was collected using a closed ended questionnaire designed to evaluate the dermatological problems faced by usage of facemasks.

Results: Among total 103 participants, 76 (73.8%) reported using face masks for more than 3months. 61(59.2%) reported itching which was moderate itching in 11(10.7%). 24% of the participants reported scratching their face without removing the mask. Worsening of the pre existing skin lesions was seen in 13% and 30% developed new lesions. Among the participants 17.5% attributed allergy due to facemask material as cause of dermatological problem. 88% were willing to continue usage of facemask.

Conclusion: Better quality facemasks, shorter duration of usage and frequent changing will help in reducing the discomfort caused by facemask and thus will help in improving the quality of health care.

Key words: Facemask, Covid19, Allergy

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INTRODUCTION

Facemasks are introduced primarily for health care professionals during surgery. After the World Health Organization (WHO) announced the pandemic of corona virus (SARS-CoV-2) responsible for coronavirus disease 2019(COVID-19) usage of facemasks has become mandatory and unavoidable for both the general population and the hospital staff [1]. Different types of facemasks are being used according to the availability and convenience. Face masks are believed to provide protection from human-to-human respiratory viral transmission [2]. Continuous usage of facemask along with the Personal Protective equipment (PPE) can cause skin damage [3].

Facemask forms an essential component of PPE and usage of which is necessary in healthcare professionals. Continuous usage of facemasks made up of different material may increase the chances of skin allergy due to friction, warmth, moisture or presence of previous allergic skin condition [4,5].Hence this study is being conducted to evaluate the skin problems faced by healthcare professionals while using facemasks which will help in analyzing the sheer need of skin care and reducing the discomfort caused by the facemasks which in turn will help in proper functioning of healthcare system.

MATERIALS AND METHODS

This was a cross-sectional study conducted at the Hassan Institute of Medical Sciences, Hassan, Karnataka, India from 1 June 2020 to 30 July 2020. The study included physicians of more than 18 years of age of either sex. Health care providerswho were not willing to participate in the study and those who wear facemask as a part of PPE(personal protective equipment) were excluded from the study. A total number of 103 participants were enrolled. The study was planned to evaluate the face mask induced dermatological problems. A structured questionnaire was used in English designed to evaluate the dermatological problems faced due to the usage of different types of facemasks. The demographic data of the study subjects in terms of name, age, sex, educational qualification and occupation were collected. The type of newly developed skin problems on usage of facemask, exaggeration of the underlying skin conditions before the usage of face mask, the possible risk factors of adverse reactions on the skin covered by the face mask, types of face masks, average duration of face mask wearing per day, patients attitude towards treating the skin condition due to face mask, were addressed in a structured questionnaire.

At the end of the study, the collected data was analyzed using SPSS software version 20. Descriptive statistical methods, means, standard deviations (SDs), medians, and frequencies were used to analyze the demographic data. Chi Square test was used to test the associations between the proposed factors and adverse skin reactions from face mask wearing. Values of P < 0.05 were considered to indicate statistical significance.

Ethics Statement

Ethical committee clearance was taken

RESULTS

A total number of 103 participants were enrolled. There were 50 (48.5%) male and 53 (51.5%) female participants with male to female ratio of 0.94. The age ranged from 22 to 56 years with mean age of 32.1068 years. There were 4 types of face masks documented as most frequently used in the study population; surgical masks (37; 35.9%), cloth masks (10; 9.7%), N95 masks (43; 41.7%). N 95 masks with respirator (13; 12.6%). Everyday changing of facemask was observed in 66 (64.1%).

More than 3 months of duration of usage of facemask was observed in 76 (73.8%) and 3- 6 hours continuous usage was observed in 56 (54.4%) of the participants. Itching was observed in 61 (59.2%) and it was mild in 48 (46.6%), moderate in 12 (19.6%) and severe in 1 (1%) participants. The prevalence of new skin lesions underneath the face masks was found in 30 cases (29.1%). It was statistically significant (p = 0.001). Acne was the most frequent new skin lesion found in the study population (10; 9.7%), followed by rashes on the face (5; 4.9%), and itch symptoms (10; 9.7%).

Table 1 shows the list of adverse skin reactions along with the numbers of cases. Table 2 shows, itching was observed in 61 (59.2%) and it was mild in 48 (46.6%), moderate in 12 (19.6%) and severe in 1 (1%) participants.

	Table 1: Itching observed participants due to facemask
	Table 2: Severity of itching caused by facemasks

Pre existing skin lesions were present in 35 (34%) and among them acne was found in majority (17; 16.5%) followed by oily face (9; 8.75%), pigmentation (5; 4.9%), allergy to sun (3; 2.9%). Table 3 shows worsening of the pre existing skin lesions was observed in 19 (54.8%) and it was statistically significant (p = 0.004). The prevalence of new skin lesions (Table 4) underneath the face masks was found in 30 cases (29.1%). It was statistically significant (p = 0.001). Table 5 shows that acne was the most frequent new skin lesion found in the study population (10; 9.7%), followed by rashes on the face (5; 4.9%), and itch symptoms (10; 9.7%).

	Table 3: Does your pre-existing skin condition worsened/improved with the usage of facemasks?
	Table 4: Development of new skin lesions
	Table 5: Type of new skin lesions due to facemask

Scratching of the face with facemask on was observed in 24 (23.3%) of the participants and 20 (19.4%) had to remove the facemask to scratch their face. Frequent touching of outer surface of the facemask was observed in 52 (50.5%) and 16 (15.5%) were not aware of it. 77 (74.8%) of the participants had opinion that facemasks can cause skin problems and 12 (11.7%) expressed their opinion of discontinuing the usage of facemask to avoid the skin problems. When asked regarding the cause for facemask induced skin problems, 33% of the participants attributed it to excessive sweating followed by allergy to facemask material (18%), moisture (15%) and friction (12%) caused by the facemask. When asked regarding the treatment for the skin problems induced by facemasks, 64 were willing to consult dermatologist and 10 had already taken treatment from dermatologist and among them skin problems were cured in 9 of the participants.

DISCUSSION

The COVID-19 pandemic is widespread and affected all populations through-out the world. World health organization has recommended wearing the facemask in general population to prevent spread of virus. Episodic adverse skin reactions related to face mask wearing was observed even in the general population. Hence this study was undertaken to evaluate the face mask induced dermatological problems during the COVID-19 Pandemic in health care providers.

In the present study itching due to facemask usage was observed in 61(59.2%) of the participants and in majority it was mild (48; 46.6%). Compared to study by Matusiak Ł, et al [6] where itching was seen in 7.7%, and skin irritation was seen in 0.9% of the study population. The development of new skin lesions were observed in 30 (29.1%). The possible explanation for this low rate of new skin lesions was due to reduced total duration of usage of facemask in a day, frequent changing of facemask.

Pre existing skin lesions were seen in 35 (34%) of the participants and worsening of the skin lesions were observed in 19 (54.28%) which was statistically significant (p = 0.004).

According to the study conducted by Ying Zuo, Wei Hua[2], it was found that mask-related skin symptoms were common in health care providers and that those with underlying IFD should be particularly cautious, as flares were associated with prolonged use. According to study by Nishi et al, [7] and Soundarya et al, [8] N95 masks were associated with more reactions than medical masks

Jacek C Szepietowski,et al. [1] conducted a internet survey to assess the itching related to the use of face masks by the general public during the COVID-19 pandemic. Responders who wore masks for longer periods more frequently reported itch. Almost 30% of itchy subjects reported scratching their face without removing the mask, or after removing the mask and then scratching.

In a study by Lan, et al. [3], self-administered on-line questionnaires were distributed to 700 participants consisting of physicians and nurses. Study demonstrated that the prevalence of skin damages of first-line healthcare workers was very high. Found that longer exposure time was a significant risk factor, which highlights that the working time of first-line staff should be arranged reasonably. According to the study by Hongal AA et al [9] the duration of facemask usage for more than 6 hours was observed in 93.7% of participants.

Kumar et al. [10] conducted a study to assess knowledge, attitude, and practices of healthcare workers regarding the facemask usage where they found out that the participants had a positive attitude but moderate-to-poor level of knowledge and practice regarding the use of face mask

Regarding the attitude of the participants towards facemask induced skin problems in our study 77 (74.8%) believed that facemasks can cause skin problems and 90 (87.4%) of them were willing to continue the usage of facemask. This shows the positive attitude towards disease prevention at the risk of curable skin problems. The limitations of the study were that this was a hospital based study with small sample size and the relation between type of facemask used and development of skin lesions was not established.

CONCLUSION

In the current study itching was observed in 61 (59.2%) of the participants. New skin lesions were observed in30 (29.1%). of the participants and there was no significant association between the usage of facemask and development of new skin lesions. Absence of pre existing skin lesions, shorter of duration of usage and frequent changing can be attributed to the low rate of new skin lesions. Better quality facemasks, reducing the duration of usage and frequent changing will help in reducing the discomfort caused by facemask and thus will help in improving the quality of health care. However a study with large sample size is needed to evaluate the various aspects of skin problems caused by facemasks.

Statement of Human and Animal Rights

All the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the 2008 revision of the Declaration of Helsinki of 1975.

Statement of Informed Consent

Informed consent for participation in this studywas obtained from all patients.

REFERENCES

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2. Responders During the COVID-19 Pandemic, ActaDermVenereol. 2020;100(10):adv00152

3. 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;83:145-7.

4. Lan J, Song Z, Miao X, Li H, Li Y, Dong L, et al. Skin damage among health care workers managing coronavirus disease-2019. J Am AcadDermatol. 2020;82:1215–6.

5. 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:e297-8.

6. Matusiak Ł, Szepietowska M, Krajewski P, Białynicki-Birula R, Szepietowski JC. Inconveniences due to the use of face masks during the COVID-19 pandemic:A survey study of 876 young people. Dermatol Ther. 2020;33:e13567.

7. Nishi N, Sonappa UK, Rajashekar TS, Hanumanthayya K, Kuppuswamy SK. A pilot study assessing the various dermatoses associated with the use of a face mask during the COVID-19 pandemic. Our Dermatol Online. 2021;12:349-53.

8. Soundarya S, Sundaramoorthy S. Unmasking the mask:COVID-19 manifestations of PPE kits. Our Dermatol Online. 2020;11:e186.

9. Hongal AA, Sijimol MV, Radhika SR, Revathi TN, Shilpa K, Eshwari L, et al. Untoward effects on the skin by the use of personal protection equipment. Our Dermatol Online. 2021;12:238-43.

10. Kumar J, Katto M, Siddiqui A A, Sahito B, Jamil M, Rasheed N, et al. Knowledge, Attitude, and Practices of Healthcare Workers Regarding the Use of Face Mask to Limit the Spread of the New Coronavirus Disease (COVID-19). Cureus.2020;12:e7737.

Notes

Source of Support: Nil,

Conflict of Interest: None declared.