Currently submitted to: JMIR Dermatology
Date Submitted: Jul 23, 2020
Open Peer Review Period: Jul 23, 2020 - Aug 9, 2020
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Does wearing a COVID-19 face mask increase the incidence of dermatological conditions for healthcare workers? A brief qualitative review of current literature.
COVID-19 is a health emergency. It was found in Wuhan, Hubei Province, China and has rapidly spread around the world, leaving no country untouched. SARS-CoV-2 is a respiratory infection characterised by a pneumonia of unknown aetiology. It is transmitted through respiratory droplets, for example: when breathing, talking and coughing. Transmission of the virus is high. Healthcare workers play critical roles in providing help to those affected with COVID-19; this could not be done without the use of personal protective equipment. Personal protective equipment, also known as PPE, involves the use of goggles, masks, gloves and gowns with the aims of protecting healthcare workers and reducing the transmission of the virus. PPE has proven to be effective in reducing the transmission of the virus, however multiple reports of skin disease and damage associated with occupational mask wear have come to light.
The objective is to review current literature of newly arising dermatological conditions as a result of occupational mask wear during the COVID-19 pandemic.
A qualitative review investigating new reports of dermatological conditions associated with occupational mask wear was carried out by referencing keywords, including: “covid mask dermatology, covid mask skin and covid mask skin damage” from the databases of PubMed, Google Scholar and ResearchGate. 287 articles were found (PubMed: 59, Google Scholar: 90, ResearchGate: 138); 40 articles successfully formed part of the study. A further 7 articles were found by manually reviewing reference lists of the included articles. The findings were tabulated and analysed under the headings: dermatological diagnosis, causes and management.
Qualitative analysis of the reviewed data was carried out. A number of dermatological conditions, as listed in Table 1, were found to be increasing due to prolonged and frequent contact of facial masks. The number of healthcare workers affected by symptoms of skin damage was significant in almost all studies, showing a worldwide problem was present. Pressure-related injuries were often the most serious complaint; recommendations to reduce this type of injury include hydrocolloid dressings, plastic handles, education and regular moisturising. Innovation of protective equipment as well as services, such as virtual clinics, need to be advanced to protect the welfare of staff.
In these unprecedented times, PPE has been an effective barrier in reducing the transmission of COVID-19 to healthcare workers. This has allowed healthcare workers to bravely provide care to patients. However, the evidence collated suggests that despite the obvious benefits of using facial masks to protect the respiratory system, there are also considerable health consequences to the skin. Future research needs to pursue the advancement of facial masks which considers both the protection of the respiratory system as well as skin care, something which this review demonstrates has been neglected.
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