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. 2021 Apr 4;85(2):225-232.
doi: 10.1111/cod.13855. Online ahead of print.

Changes in skin characteristics after using respiratory protective equipment (medical masks and respirators) in the COVID-19 pandemic among healthcare workers

Hye Sung Han  1 , Sun Hye Shin  1 , Jae Wan Park  1 , Kapsok Li  1 , Beom Joon Kim #  1 , Kwang Ho Yoo #  1
Affiliations

Changes in skin characteristics after using respiratory protective equipment (medical masks and respirators) in the COVID-19 pandemic among healthcare workers

Hye Sung Han et al. Contact Dermatitis. .

Abstract

Background: The coronavirus disease-2019 (COVID-19) outbreak has presented unique dermatologic challenges due to respiratory protective equipment (RPE)-related skin conditions.

Objective: To objectively evaluate the effects of RPE including medical masks and respirators on the skin barrier by measuring various physiological properties of the skin.

Methods: A cross-sectional study was designed. Twenty healthy healthcare workers were included in this study. Skin parameters including skin hydration, transepidermal water loss (TEWL), erythema, sebum secretion, pH, and skin temperature were measured in the RPE-covered and RPE-uncovered areas of the face 4 and 8 hours after wearing RPE and 14 hours after not wearing RPE.

Results: Skin hydration, TEWL, erythema, pH, and skin temperature increased in the RPE-covered areas after wearing RPE for 4 and 8 hours. By contrast, in the RPE-uncovered areas, skin hydration decreased and TEWL, erythema, and pH showed minimal changes over time. Based on the repeated-measure analysis, the changes in skin physiological properties over time were significantly different between RPE-covered and RPE-uncovered areas.

Conclusion: We observed that skin physiological characteristics change with the prolonged use of RPE such as medical masks and respirators. These changes may lead to various adverse skin reactions after long-term use.

Keywords: COVID-19; adverse skin reaction; healthcare workers; medical mask; respirators; respiratory protective equipment; skin biophysical properties.

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Conflict of interest statement

The authors have no conflict of interest to declare.

Figures

FIGURE 1
FIGURE 1
Points of measurement of skin properties on the face. Yellow box: measurement points on the respiratory protective equipment–covered area; blue box: measurement points on the respiratory protective equipment–uncovered area
FIGURE 2
FIGURE 2
Skin properties on the face, including (A) hydration, (B) transepidermal water loss (TEWL), (C) erythema, (D) sebum values, (E) pH, and (F) skin temperature. P‐values <.05 are significant. *P < .05, **P < .01, compared with baseline. #P < .05, ##P < .01, ###P < .001, compared with the uncovered area. V0: Baseline; V1: 4 hours after wearing the respiratory protective equipment (RPE); V2: 8 hours after wearing the RPE; V3: 14 hours after taking off the RPE. Abbreviations: KCA, KF94 respirator‐covered area; KUA, KF94‐uncovered area; MCA, medical mask–covered area; MUA, medical mask–uncovered area
FIGURE 3
FIGURE 3
Infrared photographs were taken at (A, B) baseline, (C, D) after 4 hours of wearing the respiratory protective equipment, and (E, F) after 8 hours of wearing the respiratory protective equipment
See this image and copyright information in PMC

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