Taking off your face mask
The constant wearing of the face mask — while protecting us from the virus — can be injurious to many people. Image Credit: Supplied

Dubai: The face mask is part of our ‘new normal’ daily routine and has become an indispensable accessory of our lives during the COVID-19 pandemic. From the moment we step out of homes until we return after a long day, we have to mask up. However, the constant wearing of masks — while helping protect us from the virus — can be injurious to many people.

Mind your mask hygiene

The US-based medical journal Medscape has reported a dramatic increase in mask-related injuries in the United States since the outbreak of the pandemic. Globally, similar cases are also being reported. These include skin infections, acne, allergies, irritation from the mask band behind the ears, dry eyes, and in rare cases, instances of children accidentally swallowing a piece of the soggy non-woven material, which may have partially disintegrated.

While educating people about the proper use of masks, Dr Shyam Rajamohan, specialist internal medicine at UAE-based Prime Hospital, explained why masks are posing health risks.

Trap for exhaled air

Dr Shyam Rajamohan

Dr Rajamohan said: “The common surgical face masks that are widely used are made of three layers of non-woven fabric and in between the layers, a ‘filter’ made of a polymer or polypropylene is placed to filter out infection-causing virus or bacteria. However, when the same mask is used for a long time, the air that one exhales get trapped between the mask and the skin, and coupled with sweat and moisture, can cause mask rash, acne or dermatitis.”

Prolonged use of masks

He added: “As people returned to work this year, the practice of wearing masks for a long time has gone up. People are using public transport, visiting public places and everywhere else; wearing a mask is mandatory. So much so, that we do not take mask breaks and prolonged use of one mask triggers skin infections. Faces ensconced in tight surgical masks, in some cases double masks and face shield, can result in build-up of sweat and bacteria. Also, the friction of the layers results in skin allergies, outbreaks and dermatitis.

People often wear the same mask for over eight hours and rarely take it off in public places for fear of infection. The sweat and saliva gets smeared in the inner fabric, which is nonabsorbent and causes skin outbreaks.”

Can you get ‘maskne’?

Dr Shireen Hussain

Dr Shireen Hussain, GP, Dermatology, at Aesthetica Clinic, Dubai, confirmed the rise of mask-related medical complaints among her clients.

“We have seen a significant increase in mask-related skin conditions since the emergence of the pandemic early last year. When the mask is worn for more than four hours at a stretch, it affects the delicate skin barrier, resulting in conditions such as maskne or mask-related acne, acne mechanica, in the area of distribution of the mask. It also causes cystic acne and hyperpigmentation related to the mask due to constant friction with the skin,” Dr Hussain said.

Litany of skin infections

Listing other skin conditions that are triggered by improper mask use, Dr Hussain added: “The other common complaints are of contact dermatitis, especially in the area where the elastic band courses over the ear; irritant contact dermatitis due to a defective skin barrier due to the rubber in the elastic bands; metal [nickel] from the nose piece; antimicrobials in surgical masks such as formaldehyde, and other preservatives.”

Dr Hussain said that in the last two years there was an increase in fungal infections behind the ear. “When the mask is worn for long periods of time, the tightness along with the combination of sweat and moisture causes flare up of acne and rosacea, cheilitis, which is the inflammation of the lips as well. All these conditions seriously impact the quality of life.”

Wear breathable masks

Doctors also have urged people to wear masks that are not too tight. Dr Rajmohan said it was advisable for people who are not working in the frontline health sector against Covid-19, to avoid wearing N-95 masks. “While N-95 masks are recommended for frontline workers, for people in the wider community these might prove to be too tight fitting, trapping the air one exhales, causing infection build up. I would advise people to use a two-layered cloth mask that can be washed frequently and is made of breathable natural fabric, which can minimise the risk of infection,” he added.

Dry eye

Another common problem was a noticeable increase in eye irritation and dry eye symptoms for patients wearing their masks for extended periods of time. When a face mask does not fit securely, it can push air from the nose and mouth upward, onto the eyes, causing the tear film — the liquid layer that coats the eyes’ surface — to evaporate more quickly, leading to dry eye.

Dry eye leaves the eyes feeling sore, gritty, dry, and irritated, said Dr Hussain.

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Mask care:

Make sure to change your mask every four hours.

If you have sensitive skin, use washable, layered cotton fabric masks and make sure to wash these masks every day.

Take appropriate mask breaks, but make sure no one is around to prevent exposure to any infection.

When you take mask breaks, make sure to gently clean your face with a hypoallergenic face wash, dab dry, apply moisturiser and wear a fresh mask

Carry moisturising eye drops and use these to make sure your eyes are well moisturised.

If you see the first signs of skin infections, stay indoors to avoid masking but consult a dermatologist immediately.

Source: Dr Shyam Rajamohan

Skin infections triggered by masks

Cheilitis: Inflammation of the lips, tightness, and flaring of the lips.

Koebnerisation: Spreading of a pre-existing skin condition such as psoriasis and vitiligo by friction of the fabric on the skin.

Worsening of seborrheic dermatitis may present with increased itch, redness, and peeling, particularly with prolonged mask use. This is thought to be due to the overgrowth of malassesia yeasts under the mask.

Urticaria: Pressure or contact urticate, which is rare.

Avoiding mask-related skin problems:

Try a salicylic acid-based cleanser to unclog the pores.

Use a non-comedogenic moisturiser to strengthen the skin barrier before wearing the mask. Non-comedogenic moisturisers are formulated in a manner that they do no block pores or trigger acne.

Use a lip balm to moisturise your lips.

Limit the use of make-up.

Avoid ear loop pressure by using a paper clip or hospital wristband to link the loops behind the head.

Select a comfortable mask that is not too tight.