Alarming images reveal the different types of facial reactions associated with face masks

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Wearing a face mask for long periods of time causes some people to develop serious skin conditions such as eczema and acne, dermatologists warn.

Experts examined cases of the most common causes of facial disorders directly caused by wearing face masks and other personal protective equipment, a phenomenon known as ‘maskne’.

The team from King’s College Hospital in London looked at all forms of personal protective equipment for the face, including face shields, visors, goggles, surgical masks and respirators.

The article, published in the British Medical Journal, was written to help doctors and specialists diagnose ‘maskne’ and identify pimples unrelated to PPE.

It contains a series of images showing different types of facial skin conditions caused as a direct result of wearing a mask, which were used to create a flowchart for specialists to follow to better diagnose and in turn, treat a specific condition.

Inflamed and scaly skin on the face of a 30-year-old woman with seborrheic dermatitis.  This is an inflammatory disease in which the skin becomes scaly, itchy and red.  It mainly occurs in areas rich in oil-producing sebaceous glands, such as the scalp and around the nose

Inflamed and scaly skin on the face of a 30-year-old woman with seborrheic dermatitis. This is an inflammatory disease in which the skin becomes scaly, itchy and red. It mainly occurs in areas rich in oil-producing sebaceous glands, such as the scalp and around the nose

Close-up of urticaria on the face of an 11-year-old female patient.  Urticaria, also known as hives or hives, is a skin condition in which a rash of itchy welts or lumps develops on the skin, usually on the trunk or extremities

Close-up of urticaria on the face of an 11-year-old female patient. Urticaria, also known as hives or hives, is a skin condition in which a rash of itchy welts or lumps develops on the skin, usually on the trunk or extremities

The researchers created a flowchart that specialists can follow to better diagnose and, in turn, treat a specific condition

The researchers created a flowchart that specialists can follow to better diagnose and, in turn, treat a specific condition

REQUIREMENTS FOR DIAGNOSIS OF MASKNE

Researchers say certain aspects of the patient’s history can help diagnose Maskne treatment.

This includes:

  • History of skin disease and a comprehensive drug history of prescription, over-the-counter, and complementary medications
  • Relationship with wearing a mask, including whether periods without a mask improved the problem
  • Symptoms of itching, pain and the appearance of pustules or papules
  • Duration of PPE exposure each day and whether mask breaks are allowed
  • Assess the impact on the patient’s mood, work and social life to assess severity and decide on further treatment

The coronavirus pandemic has led to a remarkable increase in the number of people wearing personal protective equipment (PPE), especially masks due to government procurement.

The term ‘maskne’ has become increasingly popular during the pandemic where it is used to describe various facial skin conditions caused by wearing a mask.

Individuals often purchase expensive but potentially ineffective treatments for these conditions, so researchers at King’s College Hospital wanted to improve diagnosis.

“In this exercise guide, we summarize the most common causes of facial rashes associated with wearing personal PPE,” the article’s authors wrote.

They also highlight the “key areas to address when assessing someone with new or worsening pre-existing facial dermatoses that they attribute to the use of facial personal protective equipment.”

The researchers, including Emily Rudd, dermatology senior clinical fellow and Sarah Walsh, dermatology consultant, wanted to make the diagnosis more consistent.

Facial skin defects related to PPE have been well described in previous research, but doctors and specialists use descriptive terms to describe outbreaks, they said.

“Based on the limited available evidence, mask-related acne and irritant contact dermatitis are the most common facial dermatoses associated with mask wear.”

A cross-sectional survey of 833 medical school staff in Thailand contributed to some of this research, including health professionals and non-healthcare workers.

That study found that 54 percent of study participants reported self-reported cases of adverse skin reactions to wearing surgical or cloth masks.

“Normally a patient presents with a new facial rash or worsening of a pre-existing dermatosis that is most pronounced in the area covered by the mask,” said the team behind the BMJ article.

Neck of a 23-year-old man with folliculitis barbae.  This is an inflammation of the hair follicles of the beard and is often caused by an infection with Staphylococcus aureus bacteria

Neck of a 23-year-old man with folliculitis barbae. This is an inflammation of the hair follicles of the beard and is often caused by an infection with Staphylococcus aureus bacteria

Contact dermatitis on the eyelid of a female patient caused by eye drops used to treat glaucoma.  Contact dermatitis is a type of eczema that is caused by a toxic reaction to a certain substance or by an allergic reaction

Contact dermatitis on the eyelid of a female patient caused by eye drops used to treat glaucoma. Contact dermatitis is a type of eczema that is caused by a toxic reaction to a certain substance or by an allergic reaction

‘Preferably such an assessment would take place in person, but video consultation is an acceptable alternative.’

Research should focus on the morphology of the eruption, its distribution and whether it is present in locations other than the face, they explained.

There are a number of conditions attached to wearing a mask, and they can either exist without the mask but be aggravated by it, or be caused by the mask, the team found.

When a condition is made worse by a mask, it is usually the result of the development of a warm, moist environment around the area that has been wearing the mask.

Pustular acne on the face of a young man.  Acne is a common name for a skin condition in which the sebaceous glands become inflamed.  The most common form, acne vulgaris, begins in adolescence and is due to overactivity of the sebaceous glands

Pustular acne on the face of a young man. Acne is a common name for a skin condition in which the sebaceous glands become inflamed. The most common form, acne vulgaris, begins in adolescence and is due to overactivity of the sebaceous glands

The team recommends making sure the mask isn’t too tight, taking breaks whenever possible, and using a wipe around the contact area.

The most common condition they discovered was irritant contact dermatitis, a form of eczema caused by direct physical or chemical injury.

It is associated with wearing masks for more than six hours and the severity depends on the type of mask and the length of exposure.

It presents as discrete, dry, scaly patches. The main treatment is regular breaks from masks and a silicone-backed bandage to protect the skin by creating a seal between the mask and the mask.

Acne rosacea on the face of a 28-year-old woman.  This condition is a reddening of the skin of unknown cause, sometimes accompanied by pustules (pus-containing blisters) that resemble acne.  One possible cause is overuse of corticosteroid creams

Acne rosacea on the face of a 28-year-old woman. This condition is a reddening of the skin of unknown cause, sometimes accompanied by pustules (pus-containing blisters) that resemble acne. One possible cause is overuse of corticosteroid creams

Other conditions include those caused by a hypersensitivity reaction to something in the mask, including rubber in elastic bands and threads used to mold it to the face.

This is best treated with a short, mild course of something like hydrocortisone ointment, the researchers explain in the letter to doctors and specialists.

They also found cases of atopic eczema, which affects up to 30 percent of children and 10 percent of adults, made worse by wearing a mask.

The doctor’s instruction letter is published in the British medical journal.

TIPS TO REDUCE THE RISK OF SKIN CONDITIONS FROM MASKS

  • Cleanse the skin with a gentle soap-free cleanser
  • Apply a light emollient at least 30 minutes before applying facial PPE
  • Apply a silicone-based barrier tape to the bridge of the nose and cheeks
  • Wipe the skin under PPE with a silicone-based barrier cloth to form a film and protect the skin from the harmful microenvironment
  • Take your time to fit the mask and make sure it’s not too tight
  • Take frequent breaks from the mask (every hour for respirators) to relieve pressure and prevent fluid build-up
  • Stay well hydrated
  • Maintain oral hygiene (brushing teeth twice a day and interdental flossing/brushing daily)

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