Veterinarians, vet students, vet techs and undergraduate vet students all are having to wear masks and other personal protective equipment (PPE) much more than they have ever before. In the case of vet students or those in pre-vet, the COVID-19 pandemic might be the first time they have ever had to wear face masks for an extended period of time.
Human health care workers wear PPE much more often than veterinarians and their staffs, so we reached out to a Fellow of the American Academy of Dermatology to help us understand how to prevent and deal with skin issues related to PPE use.
We spoke with Carrie L. Kovarik, MD, FAAD (Fellow of the American Academy of Dermatology), Associate Professor of Dermatology and Medicine at the Hospital of the University of Pennsylvania, for this webinar. You can click on the image below to watch it, or you can listen to the audio by clicking on the audio link.
Background on PPE and Skin Issues
An article from Clinical Dermatology stated: “Because diseases with an epidermal barrier interruption could enhance the virus acquisition through an indirect contact, dermatology patients might be at an increased risk for developing the infection.”
A 2006 study from Singapore during SARS looked at PPE-related adverse skin reactions in 307 staff members, mostly female nurses. Among those wearing N95 masks, 60% reported an increase in acne, 36% reported a rash, and 51% reported itch or dermatitis.
These effects increase the wearer's risk for infection. As we know, if you have any kind of uncomfortable lesion on your face—new acne, an itchy rash, an abrasion or wound—you are more likely to touch your face or adjust your mask. Every time you do that, you break the PPE protocol and risk contaminating your face.
In addition to masks and gloves, the repetitive and prolonged use of soaps, detergents, and repeated exposure to water can lead to irritated skin and an increased risk for problems.
We know from our human medical professionals that dermatology issues can be a consequence of wearing masks and other PPE, and we would like to tap into your expertise to help us better care for our skin while being socially responsible.
Dermatology Tips for PPE Wearers
NOTE: The following is summarized from Dr. Kovarik's interview. To hear all of her comments, please listen to the audio file or watch the video.
Veterinarians and their staffs will be more likely to wear surgical-type or cotton masks to protect themselves from one another rather than the N95 masks that can really cause pressure-type rashes because they are air tight.
With mask wearing, you are introducing friction on your skin all the time. Even if the mask is soft, you have something there rubbing your face. Masks with ear loops will also rub behind the ears, and you also can get rubbing on your lips.
There are masks that come out away from your face (not n95s). It is important to think about the type of mask you are using. You want soft material that is not going to cause that friction. If you have a skin condition such as acne or eczema, you night consider a mask that comes out away from your face a little bit ("duck-billed" masks).
If you wear a surgical mask, when you are walking at a brisk pace, you end up breathing it into your mouth. It is going to rub more on your skin and lips. Just that rubbing is going to dry out your face and occlude your skin and predispose you to acne and other skin issues.
The pictures you see of nurses and doctors with raw areas on their faces are from N95 masks being worn for long periods of time.
Prevention is the best thing to address these skin problems. Find a mask that fits you right. They do come in different sizes. Find a material that is soft and feels good on your face. If you do have eczema or a condition where colors or textures bother your skin, find a mask that doesn't bother your skin. Get the masks that tie behind your head rather than have the elastic that goes behind your ears.
We recommend you don't wear heavy makeup under your mask. If you are prone to acne, heavy makeup between your skin and the mask is just going to drive that makeup to clog your pores.
Dermatologists do recommend using a moisturizer under face masks. That can create a nice barrier between your skin and the mask to help prevent the friction. Also consider something with SPF on your face because if you get any sun irritation, that's also going to create some friction.
We had a doctor ask about sun lines, and as a dermatologist I recommend using SPF on your face anyway, and that will keep you from getting those sun lines.
You can buy Vaseline or other petrolatum-based moisturizer in convenient lip applicators. That's the best thing. No reason to put lipstick on if you are going to be wearing a mask on all the time; that is also going to add to the rubbing.
If skin problems are becoming uncomfortable or uncontrollable, dermatologists are good at telemedicine if you don't have time to visit one in person. She said dermatologists are a visual specialty, and most dermatologists are much more accessible now probably because of the pandemic. They are set up to do telemedicine from their offices. If you are having a problem and some of the tips I suggest below don't work, you can see a dermatologist virtually.
Rashes on the face from masks are something we can see on televideo and help veterinarians or others out with.
Tips for Mask Wearers
Once you get home, take your mask off and wash your face with a bland soap or cleanser just to get the grime off from the day. If you have a history of acne, use your acne medication at home. Don't use your acne medicine under your mask. It can make it more potent than it used to be.
We use some acids and retinoids that under occlusion—between your skin and your mask—they become very potent and you'll end up with a red face. Wear it at night, even if you just get the over-the-counter benzole peroxide type treatments, those can become pretty drying under your mask. So use them at night and wash your face in the morning before you put on your mask. And don't forget your moisturizer!
Dermatologists like products that are minimal. The more fragrances and ingredients, the more irritation they can bring on. My patients come in with some really expensive products, but I like very "bland" for sensitive skin that you can buy at the store. Moisturizers with dimethicone that come in a cream creates a little more barrier between the skin and the mask; it's a good moisturizer, and it stays on better.
Tips for Hands
Washing is always the preferred way to clean your hands if you can, because the alcohol-based hand sanitizers and are very drying on your hands. We want to keep our hands clean. One thing recommended is to wash your hands when you need to. When you are at home, you don't need to wash your hands five times an hour. Wash them when you need to, and minimize it when you can. Don't forget to moisturize when you can, although it is hard to wear moisturizer under gloves.
At work, if you have a time to take your gloves off, take time to moisturize your hands to replenish that moisture that you've lost.
Alcohol-based sanitizers work well, so if you can't wash your hands they are good. But try to strike a balance between washing and using those. At hospitals, hand sanitizers are on the walls everywhere so we tend to use them every time we walk by. Then we end up with cracks in our hands that is an invitation for bacteria and other things to come through our skin.
Skin barrier wipes are more for people that are wearing masks and have sore areas on their skin. If you are wearing masks and have soreness on bridge of nose or behind your ears—which can happen with all types of masks—the skin barrier wipes have a soft silicone that doesn't irritate your skin and creates a barrier between your skin and the mask. So it reduces the friction. Our nurses here use that if they get sore place on their skin.
Find a mask that is comfortable, because we are going to be in this for a while. People get "mask fatigue," but it's really important to continue wearing your mask and make it second nature. But when people get these issues on their skin, they want to quit wearing it or take it down. So finding a mask that is really comfortable and preventing these issues is key.
Same thing with your hands. If you can prevent it, it is more comfortable to wear gloves. If you do start getting fissures on your fingers, just glob on the vaseline at night and put socks on them and they will be "baby soft" in the morning.
One Tip for Veterinarians
Veterinarians and those who work with animals, it is a good idea to keep a lint roller around. Then if you take your cloth mask off, you can lint roll it before you put it back on to get the horse hair out!