Facial dermatoses induced by face masks: A systematic review and meta-analysis of observational studies

Abstract

The use of masks for infection control was common in the COVID-19 pandemic. As numerous cross-sectional studies have suggested a link between the use of such masks and various facial dermatoses, a systematic review and meta-analysis of published studies was conducted to evaluate this association, as well as potential risk factors for the development of such facial dermatoses. Observational studies were searched for in MEDLINE, EMBASE and the Cochrane Central Register. Thirty-seven observational studies with a total of 29 557 study participants were identified. This study was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 checklist and quality was assessed via the Newcastle-Ottawa Quality Assessment Scale., Overall prevalence of facial dermatoses was 55%. Individually, acne, facial dermatitis, itch and pressure injuries were consistently reported as facial dermatoses, with a pooled prevalence of 31%, 24%, 30% and 31%, respectively. Duration of mask-wear was the most significant risk factor for the development of facial dermatoses (95% CI: 1.31-1.54, p < 0.001). Overall, facial dermatoses associated with mask wear are common, and consist of distinct entities. They are related to duration of use. Appropriate and tailored treatment is important to improve the outcomes for these affected patients.

Keywords: acne; face mask; facial eczema; itch; meta-analysis; systemic review.

FIGURE 1

Preferred Reporting Items for Systematic Reviews and Meta‐Analyses flow diagram

FIGURE 2

Prevalence of facial dermatoses in general, and individual facial dermatoses that are attributed to the use of face masks

FIGURE 3

Relative risks of developing facial dermatoses when wearing masks for >4–6 h compared to <4–6 h

FIGURE 4

Relative risks of developing facial dermatoses when using respirators in comparison to surgical masks