Skin disease affecting the hands and face is extremely common at the moment as a result of increased handwashing, use of hand sanitizing gel and widespread and prolonged wearing of PPE. I have previously given some advice for dealing with the adverse effects of frequent handwashing, and that advice still stands. However, here is some information and advice as to how to manage the effects on the facial skin.
Many people working in healthcare settings are now wearing some form of PPE, including those who might not have needed to pre-Covid-19. More significantly, PPE including tightly-fitting FFP3 masks, goggles and face shields are being worn by large numbers of frontline healthcare professionals, often for prolonged periods of time, and these cause more severe facial skin problems. A study from Singapore during the SARS epidemic in 2003/04 gives an idea of the scale of the problems that may be encountered*.
Surgical and paper masks do not seem to cause many problems to wearers, although the increased humidity created behind the mask against the skin may be the cause of an acne flare-up.
FFP3 masks also create hot and humid conditions behind the mask, and block (or occlude) the pores to cause an acne flare-up. They can also cause an irritant or allergic contact dermatitis** due to components of the mask. This dermatitis will develop over a period of a few days. A small number of people may react to components of the mask by developing a wheal, or raised, red, itchy area like ’hives’ within minutes of donning the mask (contact urticaria). Fitted masks and goggles also cause mechanical trauma to the skin.
It is therefore no surprise that PPE pressure points are the most commonly affected sites, particularly over the bridge of the nose, but also the cheeks and forehead. The symptoms might include dryness, tightness and itching, redness and scaling, raised papules and pustules (PPE pimples!) and more severe changes where the skin surface is broken with maceration and fissures or splitting.
It is important to take all measures possible to minimize these facial symptoms, as they may result in an increased tendency to touch the face, and potentially spread the Coronavirus, and severe facial skin disease might result in the inability to wear PPE until it settles. However, trying to alter the pressure points of the tightly fitting PPE masks and goggles to allow continued wear might reduce their effectiveness by altering the seal and must be avoided.
So what to do?
- Avoid prolonged wearing of FFP3 masks and goggles where possible, ideally removing every 2 hours.
- Do not make any changes to PPE donning protocols that might reduce effectiveness, such as trying to shift pressure points or applying a moisturizer prior to donning a fitted mask.
- At the end of a shift and outside work treat your skin gently: avoid soaps and detergents, and use a soap substitute such as Cetaphil instead, and apply a moisturizer such as Epaderm cream or ointment to any areas of itchy, dry, red or scaly areas. Ointments are greasier than creams, and so you might find an ointment better at night and use a cream during the day.
- More severe cases of dermatitis might need a mild or moderate steroid cream or ointment. If the dermatitis becomes infected, or wet and weeping, a steroid cream with an added antibiotic may be needed. 1% hydrocortisone is available OTC, but any stronger topical steroid, or one containing and antibiotic requires a prescription.
- Acne should improve with OTC preparations. Use a skin range aimed at acne-prone skin, such as Neutrogena, Eucerin or La Roche Posay Effaclar ranges. Your pharmacist will be able to advise regarding OTC preparations, including benzoyl peroxide. This may be irritant however. Topical antibiotic treatments require a prescription.
- If a contact allergy is suspected you will need patch testing to confirm this, but this form of allergy testing is currently suspended in almost all hospitals. It is worth contacting your dermatology department however, for general advice regarding management of facial skin problems caused by PPE, and to discuss whether a limited form of patch testing to the masks might be possible in the short term.
Article by Consultant Dermatologist Dr Fraser-Andrews
* Adverse skin reactions to personal protective equipment against severe acute respiratory syndrome- a descriptive study in Singapore C Foo et al, Contact Dermatitis. 2006;55:291-4
** dermatitis and eczema are interchangeable terms