The Association of the Prolonged Use of Personal Protective Equipment and Face Mask During COVID-19 Pandemic With Various Dermatologic Disease Manifestations: A Systematic Review

Abstract

COVID-19 is a novel coronavirus that represents a great global health concern. It is transmitted between individuals through respiratory particles, and as there is no established effective treatment currently for the virus, it is necessary to use protective strategies such as face masks. Healthcare providers and individuals serving outdoors are required to work for long durations wearing personal protective equipment (PPE). Wearing such protective equipment may have short-or long-term effects on the skin health of these individuals. We aim to assess the prevalence and types of dermatological manifestations associated with wearing PPE for a long time during the COVID-19 pandemic period by reviewing the previous studies conducted on this subject.The medical literature, including the databases of PubMed and Google Scholar, from 2019 to 2021 was explored. The search terms included a combination of "Impact of PPE and dermatological outcome," "Wearing PPE for a long time and dermatological manifestations," "Face mask-wearing and dermatological complications," and "Wearing PPE and dermatological manifestations." The inclusion criteria are original full-text articles that reported the association of wearing PPE and dermatological manifestations and outcomes.A total of 70 articles were obtained, among which only 10 articles were eligible for the inclusion criteria. These 10 studies included a total number of 7,643 participants and covered different countries of the world. The extracted data were summarized in a table to facilitate the collection of the important findings.Dermatological complications are frequently reported in people wearing PPE and face masks, especially the ones caused due to PPE among healthcare providers as they tend to use these protective measures for longer durations.

Mask-induced facial dermatoses during the COVID-19 pandemic: A cross-sectional study in a tertiary medical center in the Philippines

“…In addition, no significant correlation was found among those who used face masks for 8 hours or more, but many participants reported that their symptoms occurred when they used masks for more than 17 hours. This is consistent with a systematic review published by Barnawi et al,2 in which the occurrence of dermatological complications from wearing personal protective equipment (PPE) was reported to be more apparent among individuals wearing PPE for more than 4 hours a day. Many participants described symptoms that appeared when they use masks for 5 days a week.…”

P2/N95 respirators & surgical masks to prevent SARS-CoV-2 infection: Effectiveness & adverse effects

“…Thus, seeing greater odds of HCWs wearing respirators experiencing pressure sores, facial itching or irritation, headaches and shortness of breath or respiratory distress is unsurprising. These effects might also be exacerbated the longer the mask is worn for ( 19 , 47 ). Although these findings are supported by similar recently published literature ( 48 ), the small number of studies, wide confidence intervals, small sample sizes and the substantial potential for confounding (i.e.…”

“…However, mandating mask and respirator use might not lead to use, suggesting that barriers to use are important considerations when mandating specific PPE ( 16 ). During the pandemic, HCWs have needed to wear PPE for several hours and days in a row, rendering them susceptible to adverse events (AEs) associated with prolonged contact between mask material and the skin ( 17 , 18 , 19 ), such as injury and absenteeism ( 20 ), prompting measures to be taken to protect the skin of HCWs wearing PPE ( 21 ).…”

Efficacy of Surgical Masks Versus N95 Respirators for the Prevention of COVID-19 in Dental Settings: A Systematic Review

“…In the dental field, wearing a custom-fit N95 respirator with a patent seal all around offers superior protection against infectious bioaerosols [18]. However, prolonged wearing of RPE and other additional PPE compresses the cheeks, forehead, bridge of the nose, and ears, which can be the main reason for head and face pressure and skin damage [22][23][24][25]. The lack of proper training in PPE use and successive wearing of them further complicates these issues [21].…”