Skin complications related to the use of private protective equipment and “mask” – what may be done to stop and treat them

These days, we hide behind masks and for the fitting reasons: to guard ourselves and others from infectious diseases. Healthcare staff are required to wear masks and private protective equipment (PPE) for prolonged periods of time, often for your entire shift, whether it’s 8, 12 hours or longer. This practice of prolonged use has been used throughout the COVID-19 pandemic to conserve supplies of private protective equipment (Centers for Disease Control and Prevention [CDC], 2020). Currently, physicians proceed to wear PPE for long hours, putting them at high risk of skin complications corresponding to facemask-induced dermatitis, also called irritant contact dermatitis. Symptoms include dryness, scaling, mild erythema, rash, swelling, inflammatory pustules, maceration, and skin breakdown on the bridge of the nose, brow, cheeks, and behind the ears (Kelechi, Brunette, & Lee, 2020).
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Pacis, Azor-Ocampo, Burnett, Tanasapphaisal, and Coleman (2020) conducted a top quality improvement program to judge using prophylactic dressings to stop skin damage when using N95 respirators. They evaluated six various kinds of dressings designed to guard the skin from friction, pressure and moisture; comfortable to wear; and straightforward to use and take away without creating an aerosol of particles that would cause self-contamination. The only dressing that met all of those criteria was Adapt No Sting Skin Protective Wipe, an alcohol-free liquid acrylic dressing. Researchers found that applying this product to areas of friction before putting on an N95 respirator would offer comfort, prevent skin friction, and maintain an adequate seal. The use of topical padded dressings (i.e., foam, hydrocolloid) must be avoided with tight-fitting respirators as they might affect the fit and seal and reduce its effectiveness (Society of Wound, Ostomy and Continence Nurses [WOCN] Board of Directors Task Force, 2020). Padded dressings that don’t require a skin seal could also be used under face shields so long as this doesn’t impair the functionality of the mask (Kelechi, Brunetka, & Lee, 2020).

Prevention and treatment of skin injuries related to personal protective equipment

Below are several strategies to stop and treat PPE-related skin injuries specifically for healthcare staff (Kelechi, Brunetka, & Lee, 2020; WOCN Board Task Force, 2020).

• Before applying the mask, wash your face with a mild face cleansing gel and remember to dry it thoroughly.
• Apply a skinny layer of moisturizing face milk throughout your face.
  • If you might be liable to pimples, use a non-comedogenic product.
  • If you are inclined to sweat or turn into excessively wet, use an alcohol-free barrier film (cyanoacrylate moisture barrier).
  • Apply to areas where the mask may touch the skin or cause friction, corresponding to the bridge of the nose, cheeks, tops of the ears, or brow; avoid the attention area.
  • Allow products to dry for at the least 90 seconds before putting on the mask.
  • Barrier foils don’t must be removed.
  • Use day by day, but reduce use if residue occurs.
  • Avoid Vaseline-based products as they might affect the seal of the mask; these products may be applied to damaged skin in the event you usually are not wearing a mask.
• Beware of allergic reactions to the next materials:
  • Glue strips or elastic along the nose
  • Metal wire, sometimes fabricated from nickel
  • Sterilizing sprays used for reusable masks

• If contact dermatitis develops, a low-strength topical corticosteroid must be used to alleviate skin inflammation.
• In case of skin loss, use a breathable, non-corrosive cyanoacrylate-based protector/seal as much as 3 times day by day.

Maskne

The COVID-19 pandemic has resulted in a rise within the incidence of mask-related pimples and the birth of a brand new term: “maskne.” Maskne is a type of “facial dermatosis that occurs in areas of friction due to the use of masks, respirators, and personal protective equipment” (Sinha and Singh, 2020). According to Teo (2020), masking is probably going brought on by hair follicle occlusion and is directly related to mechanical stress corresponding to pressure, occlusion, or friction, also referred to as pimples mechanics, and changes within the skin microbiome, including heat, pH, and moisture. Contributing aspects include genetic predisposition, older age, pre-existing skin problems, long hours of PPE use, incorrect PPE size, tighter PPE, and use of adhesive tape (Sinha and Singh, 2020).
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Association of the American Academy of Dermatology ([ADA]2021) recommends several suggestions to assist prevent masking, not just for healthcare staff but in addition for most people:

1. Cleanse and moisturize day by day.
   1. Clean with an antibacterial, mild, odorless cleaner.
   2. Moisturizers add a layer of protection and reduce dryness.
      1. Look for moisturizers that contain ceramides, hyaluronic acid, dimethicone.
      2. Use before and after putting on the mask.
2. Apply Vaseline to your lips after washing your face, before applying a mask and before going to bed.
3. Avoid putting makeup under your mask.
   1. If makeup is obligatory, use products which might be non-comedogenic and non-comedogenic.
4. Avoid recent skincare products that will irritate your skin, corresponding to chemical peels, exfoliants, or retinoids for the primary time.
5. If skin irritation occurs, limit using certain skincare products corresponding to leave-on salicylic acid, retinoid, or aftershave.
6. Choose masks that (Teo, 2020):
   1. They are comfortable and well-fitting.
   2. They have smooth surfaces without folds.
   3. Have at the least two layers of fabric.
   4. They are fabricated from natural, breathable UPF 40+ materials corresponding to cotton.
   5. Include adjustable ear loops.
   6. They don’t have any metal parts on the nose.
7. Take a 15-minute break from the mask every 4 hours.
8. Fabric masks must be washed after each use.

Moisturizing and day by day skincare are necessary elements in maintaining healthy skin. As healthcare staff, we regularly neglect our own needs in an effort to look after others. Take care of yourself – and your skin.

Association of the American Academy of Dermatology (n.d.). 9 ways to avoid skin problems with a face mask. Retrieved January 11, 2021 from https://www.aad.org/public/everyday-care/skin-care-secrets/face/prevent-face-mask-skin-problems

Centers for Disease Control and Prevention (2020). Coronavirus disease 2019 (COVID-19) strategies to optimize the availability of N95 respirator masks. Retrieved January 14, 2021 from https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirators-strategy/index.html

Kelechi, T. J., Brunette, G., and Lee, L. W. (2020). Personal Protective Equipment Associated Dermatitis(4), 324-325. https://www.doi.org/10.1097/WON.0000000000000673Â Â

Pacis, M., Azor-Ocampo, A., Burnett, E., Tanasapphaisal, C., and Coleman, B. (2020). Prophylactic dressings to take care of skin integrity of health care staff when using N95 respirator masks while stopping contamination with the novel coronavirus, quality improvement project. (6), 551-557. https://www.doi.org/10.1097/WON.0000000000000713 Â Â

Sinha, A. and Singh, A. R. (2020). An unexpected risk that masks will turn into fashionable. , 213-214. https://www.doi.org/10.34172/ijoem.2020.2211Â Â Â

Teo, W. (2021). Diagnostic and management considerations for maskne within the era of COVID-19. y, (2), 520-521. https://doi.org/10.1016/j.jaad.2020.09.063

Task Force of the Board of the Wound, Ostomy and Continence Society (WOCN). (2020). Guidelines for maintaining skin health when using face masks for long periods of time. (4), 317-318. https://www.doi.org/10.1097/WON.0000000000000677 AND

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