Recently, my wife and I were in Costco. We were both wearing masks. A very large gentleman without a mask sneezed three feet away from my wife. This was not a small sneeze. It was a loud, open-mouthed, aerosolization of millions of potential viral particles into the air. At that moment, he may have been a carrier of COVID-19, and infected several people around him, including my wife. He should have been wearing PPE!
With the advent of Covid-19, PPE is a term new to the public, and even many in the medical profession. PPE means "personal protective equipment". Per OSHA (https://www.osha.gov/SLTC/personalprotectiveequipment/), "PPE is equipment worn to minimize exposure to hazards that cause serious workplace injuries and illnesses. These injuries and illnesses may result from contact with chemical, radiological, physical, electrical, mechanical, or other workplace hazards. Personal protective equipment may include items such as gloves, safety glasses and shoes, earplugs or muffs, hard hats, respirators, or coveralls, vests and full body suits."
Two months ago, the government said that masks do NOT prevent the spread of the virus. I questioned the veracity of this from the very beginning. This recommendation went against common sense. If you have COVID-19 and wear a mask, the mask will significantly diminish the aerosolization of viral particles and protect unaffected individuals. If you do not have COVID-19 and wear a mask, the amount of viral particles you inhale is much less than if you did not wear the mask. Residents of Asian countries have been wearing masks for years. South Korea was able to control the virus rather quickly, and I believe, much of this control was from masks, social distancing, infrared thermometers, and rapid testing.
Now many states, including Colorado, are requiring every person to wear a mask when leaving the house. This will be the norm for awhile. A proper fitting mask should form an airtight seal against the skin around nose and mouth, the most common sites for COVID-19 to enter the body.
Skin-related irritations from masks are inevitable and include the following:
- Pressure from the edge of the mask and the straps can cause flattening of the epidermis, and depressions in the dermis and subcutaneous fat. While unlikely to cause necrosis, it is important to release the pressure and allow the skin to "breathe".
- Friction injuries from the edges of the masks and straps can cause shear injuries to skin, which results in loss of the barrier function of the skin. Peeling, irritation, raw surfaces, sores and open wounds are possible. If this occurs, change the type of mask used, and use aquaphor or antibiotic ointment. If you are using medical skincare, stop using creams with glycolic acid and tretinoin, which thin the top layer of the skin, the stratum corneum, and reduce the barrier capability of the skin.
- Contact dermatitis from the material of the mask and straps may result in a rash with redness, swelling, and itching.
- Acne flares may arise from clogging of pores.
- Post-inflammatory hyperpigmentation (PIH) is an increase in pigmentation of the skin due to irritation. This is more common in darker skin types and the initial treatment is elimination of the irritant, i.e. the masks and straps. Medical skincare with hydroquinone may be required to stop the formation of pigmentation. Fortunately, PIH is almost always reversible.
- Keloids and hypertrophic scars are thicker than normal scars, and have been reported behind the ears from masks withe "loop" straps. These scars are more common in certain ethnic groups, and the ears, neck and scalps are the most common areas of the face to be affected. Treatments for keloids and hypertrophic scars include removing the irritant, steroid injections, laser treatments, excision, and scar revisions.
In summary, masks are essential to protect individuals from getting COVID-19, but may also disrupt the barrier function of the skin. Here are my recommendations:
1. Wash your face twice a day.
2. Stop creams with glycolic acid and tretinoin (Retin-A) if irritation occurs.
3. Apply aquaphor to the facial skin to decrease the coefficient of friction and shear forces.
4. Remove masks frequently to relieve pressure and allow the skin to "breathe".
5. Use antioxidants to strengthen your skin.
6. Use physical sunblocks with titanium and zinc to protect the skin.