The use of personal protective equipment (PPE) is a necessary measure for healthcare workers (HCW’s) as it allows us to safely fulfil our caring roles. Its use is to reduce exposure to COVID-19, and to minimise spread to patients and loved ones. Unfortunately, persistent wearing of PPE (masks, goggles, face shields) worsens symptoms of existing skin problems (e.g acne and eczema) and can result in new dermatological issues, including:
Pressure sores
Skin break down
Redness
Itching
Spots
Dryness
Peeling
As a doctor, I feel my best when I can look after patients, and PPE allows me to do that. As a skincare specialist, I know PPE can cause problems for many people, so I would like to urge you to start being mindful of the possible effects, inspect your skin regularly (that’s hands and face) and prepare to prevent the damage.
This is all the more important following this week’s announcement, advising the public to wear face coverings.
Hopefully, some of the HCW’s reading this will have nabbed a few skincare goodies. With the knowledge here you can go ahead and nourish that skin and not have to worry about “when the mask comes off”.
How likely are you to be affected?
97% of HCW’s fighting the virus in China, developed skin damage from personal protective equipment. UK “COVID-Wards” or “High Risk Zones”, where full PPE/FFP3 is required, may expect similar rates of skin damage. Common areas affected include the nose, cheeks, forehead, and the hands.
The Damage
Maceration is the term used when skin softens and breaks down due to being to contact with too much moisture (hyper-hydration). Unfortunately, the protective masks are not so protective against this - In fact, it is a perfect trap for excess moisture!
Then, there is the effect of direct pressure to the face, British doctors have noted injuries as significant as grade two pressure sores to the nose. This is strongly associated with prolonged wearing of FFP3 masks. If the fastening on your mask starts to weaken, or if it is poor fitting, friction of the mask against the skin is also likely to cause damage.
There are concerns that these skin complaints will result in more frequent touching of the face and poor compliance with PPE protocols, which increases the risk of exposure and transmission of the virus.
Personally, I am already noticing changes to my skin, mainly acne and dryness. I also find that the masks rub against my nose, behind my ears, and puts pressure under my eyes.
Increasing sensitivity of the skin is likely due to irritation from the mask itself (contact dermatitis). Dryness can be a result of the hot, humid environment, plus the blockage of oil producing glands and hair follicles beneath the mask, promotes the formation of spots.
What can I do about it?
Luckily, there are measures we can take to protect our skin whilst properly adhering to infection control protocols.
The NHS recommends:
Keeping your skin clean and hydrated
Applying moisturiser at 30 minutes before wearing PPE
Taking regular breaks, where you should clean and dry the skin
Drinking plenty of water to stay hydrated
Alongside these generic measures, here are some further suggestions for the more specific skin conditions you could experience.
For Wounds
The break in the skin should be rinsed in saline to clean the area. At night, small cuts or sores can be coated in Vaseline, which keeps the wound clean, covered, and moist. In this way, the protective layer of petroleum jelly can aid healing and reduce scarring. Zinc oxide barrier cream could also be useful in creating a physical protective layer against dampness and bacteria. Another benefit is that it’s anti-inflammatory, but a major downside is that it can really sting!
Avoid exfoliants, including chemical exfoliants AHA’s/BHA, astringents or toners with high alcohol contents, and retinoids.
If you require a dressing for pressure damage, a low-profile dressing (such as a Hydrocolloid dressing) can be over the nasal bridge without compromising the fit of your mask. Just remember to wash your hands before touching any wound.
(Note: It is recommended that you should be re-fit-tested if using dressings beneath the seal of your protective mask)
For Itching/Rashes
Ensure the skin is well cleansed (I’d recommend water based, unscented cleansing lotion, rather than a foaming or gel wash which can increase skin sensitivity) and moisturise with fragrance free products at least twice a day, but ideally at each mask break. Barrier creams can also be used to create that protective layer, but moisturiser will be key to lock in water to maintain the skins function. You may need to take a break from your regular products like exfoliators, AHA’s/BHA’s and retinol, plus consider the use of a daily non-drowsy antihistamine. If you are finding your skin becoming dry, the addition of hyaluronic acid containing products, vitamin E oils and thick moisturising creams, are really going to make a difference.
For Acne
If spotty-ness or acne is your main skincare concern, you need to be smart about your skincare. Cleanse with a foaming or gel cleanser, those with salicylic acid would be great. Use a spot treatment, acid toner or astringent for anti-inflammatory/antibacterial benefits. Exfoliate to unclog pores; you can use whatever works for you, as long as it doesn’t irritate your skin too much, so choose wisely.
Clay based treatments or masks can provide relief from excess oil and mattify the skin. Importantly, moisturise your skin! It is difficult to know what to use and run the risk of clogging pores, but as a general rule for acne prone skin, a water-based/light moisturiser is best.
Other things you can do:
Review your regular products to make sure that they are suitable for the current condition of your skin
Avoid makeup, especially under your mask as it can clog pores, increasing the chance of spots/acne
Make sure you get good quality sleep, as this is when the skin can repair and regenerate
Cleanse your face regularly, patting the skin dry
Stay hydrated
Take regular breaks
At times like these, self-care (as well as skincare) will go a long way- so treat yourself and your loved ones to products that will really make a difference. Buy a voucher for a local beautician or hairdressers to keep them going. look for local shops selling beautiful things that will make your “you-time” so much more enjoyable. Send your stressed-out college a handwritten card or some baked goods.
All in all, my message to you is twofold 1. You work hard to make a difference in this pandemic, so your skincare products should too.
2. Be kind to yourself, be kind to others, and make the days lovely.
(Not a Dermatologist, no conflict of interest, not sponsored, any information given here should not replace the advice of your doctor)
1. BMJ 2020;369:m1743 doi: 10.1136/bmj.m1743
2. Darlenski R, Tsankov N. Covid-19 pandemic and the skin-What should dermatologists know?. Clinics in Dermatology. 2020 Mar 24.
3. Foo CC, Goon AT, Leow YH, Goh CL. Adverse skin reactions to personal protective equipment against severe acute respiratory syndrome–a descriptive study in Singapore. Contact dermatitis. 2006 Nov;55(5):291-4.
4. Lan J, Song Z, Miao X, Li H, Li Y, Dong L, Yang J, An X, Zhang Y, Yang L, Zhou N. Skin damage among health care workers managing coronavirus disease-2019. Journal of the American Academy of Dermatology. 2020 May;82(5):1215.