The coronavirus infectious disease 2019 pandemic has resulted in health care workers donning personal protective equipment (PPE) for extended periods.
Objectives
The aims of the study were to review facial PPE (surgical masks and N95 respirators) ingredients, to identify facial PPE resterilization techniques, and to recommend strategies for prevention and management of facial PPE–related dermatoses.
Methods
Twenty-one facial PPE (11 N95 respirators, 10 surgical masks) were reviewed. Resterilization techniques were identified. Personal protective equipment–induced occupational dermatoses and management strategies were explored.
Results
Polypropylene is the most common chemical identified in facial PPE. Most masks contain aluminum at the nosepiece. Two surgical masks released nickel. Facial PPE dermatoses include irritant contact dermatitis, allergic contact dermatitis, acne, and contact urticaria. Strategies for prevention and management of facial PPE occupational dermatoses are discussed.
Conclusions
There are increasing reports of occupational dermatoses associated with facial PPE. This review discusses the components of facial PPE, mask resterilization methods, and strategies for prevention and management of facial PPE dermatoses.
Get full access to this article
View all access options for this article.
References
1.
FooCCI, GoonATJ, LeowYH, et al.Adverse skin reactions to personal protective equipment against severe acute respiratory syndrome—a descriptive study in Singapore. Contact Dermatitis, 2006; 55(5):291–294.
2.
LinP, ZhuS, HuangY, et al.Adverse skin reactions among healthcare workers during the coronavirus disease 2019 outbreak: a survey in Wuhan and its surrounding regions. Br J Dermatol, 2020; 183(1):190–192.
Battelle. Final Report for the Bioquell Hydrogen Peroxide Vapor (HPV) Decontamination for Reuse of N95 Respirators. Columbus, OH; 2016. Available at: https://www.fda.gov/media/136386/download. Accessed July5, 2020.
MillsD, HarnishDA, LawrenceC, et al.Ultraviolet germicidal irradiation of influenza-contaminated N95 filtering facepiece respirators. Am J Infect Control, 2018; 46(7):e49–e55.
10.
HeimbuchBK, WallaceWH, KinneyK, et al.A pandemic influenza preparedness study: use of energetic methods to decontaminate filtering facepiece respirators contaminated with H1N1 aerosols and droplets. Am J Infect Control, 2011; 39(1):e1–e9.
11.
MaQX, ShanH, ZhangCM, et al.Decontamination of face masks with steam for mask reuse in fighting the pandemic COVID-19: experimental supports. J Med Virol, 2020. doi: 10.1002/jmv.25921. [Epub ahead of print].
12.
Sánchez-MorillasL, Reaño MartosM, Rodríguez MosqueraM, et al.Delayed sensitivity to prolene. Contact Dermatitis, 2003; 48(6):338–339.
13.
MaloJL, CartierA, PineaultL, et al.Occupational asthma due to heated polypropylene. Eur Respir J, 1994; 7(2):415–417.
14.
DonovanJ, Skotnicki-GrantS. Allergic contact dermatitis from formaldehyde textile resins in surgical uniforms and nonwoven textile masks. Dermatitis, 2007; 18(1):40–44.
Raison-PeyronN, BergendorffO, BourrainJL, et al.Acetophenone azine: a new allergen responsible for severe contact dermatitis from shin pads. Contact Dermatitis, 2016; 75(2):106–110.
LungH, HuangL, LinH, et al.Allergic contact dermatitis to polyethylene terephthalate mesh. J Investig Allergol Clin Immunol, 2009; 19(2):161–162.
21.
MowitzM, HermanA, BaeckM, et al.N,N-dimethylacrylamide—a new sensitizer in the FreeStyle Libre glucose sensor. Contact Dermatitis, 2019; 81(1):27–31.
22.
Raison-PeyronN, MowitzM, BonardelN, et al.Allergic contact dermatitis caused by isobornyl acrylate in OmniPod, an innovative tubeless insulin pump. Contact Dermatitis, 2018; 79(2):76–80.
23.
DeKovenJG, WarshawEM, ZugKA, et al.North American Contact Dermatitis Group patch test results: 2015–2016. Dermatitis, 2018; 29(6):297–309.
24.
SiemundI, MowitzM, ZimersonE, et al.Variation in aluminium patch test reactivity over time. Contact Dermatitis, 2017; 77(5):288–296.
25.
RystedtI.Factors influencing the occurrence of hand eczema in adults with a history of atopic dermatitis in childhood. Contact Dermatitis, 1985; 12(4):185–191.
26.
DeleuranMG, AhlströmMG, ZachariaeC, et al.Patch test reactivity to aluminium chambers. Contact Dermatitis, 2019; 81(4):318–319.
27.
WardJ, WalshR, BelletJ, et al.Allergic contact dermatitis to aluminum-based chambers during routine patch testing. In: Presented at the American Contact Dermatitis Society Annual Meeting; Denver, CO; 2020.
28.
KosannM, BrancaccioR, CohenD. Occupational allergic contact dermatitis in an obstetrics and gynecology resident. Am J Contact Dermat, 2003; 14(4):217–218.
29.
HamannCP, RodgersPA, SullivanK. Allergic contact dermatitis in dental professionals: effective diagnosis and treatment. J Am Dent Assoc, 2003; 134(2):185–194.
30.
Di AltobrandoA, GurioliC, VincenziC, et al.Allergic contact dermatitis caused by the elastic borders of diapers. Contact Dermatitis, 2020; 82(1):71–72.
31.
Perez-CrespoM, SilvestreJF, LucasA, et al.Contact dermatitis due to stockings. Dermatitis, 2009; 20(4):221–222.
32.
LiBS, CaryJH, MaibachHI. Relapsing polyisoprene glove allergic contact dermatitis: another call for more complete glove package label declaration. Contact Dermatitis, 2018; 79(4):242–243.
33.
LanJ, SongZ, MiaoX, et al.Skin damage among health care workers managing coronavirus disease—2019. J Am Acad Dermatol, 2020; 82(5):1215–1216.
34.
AguirreA, ZabalaR, Sanz de GaldeanoC, et al.Positive patch tests to hydrogen peroxide in 2 cases. Contact Dermatitis, 1994; 30(2):113.
35.
TanKT, GreavesMW. N95 acne. Int J Dermatol, 2004; 43(7):522–523.
36.
AlankoK, SusitaivalP, JolankiR, et al.Occupational skin diseases among dental nurses. Contact Dermatitis, 2004; 50(2):77–82.
LeBlancK, HeerschapC, ButtB, Bresnai-HarrisJ, WiesenfeldL.Prevention and management of personal protective equipment skin injury: update 2020. NSWOCC. Available at: www.nswoc.ca/ppe.
40.
AlvesP, MouraA, VazA, et al.PRPPE I COVID 19. Prevention of skin lesions caused by personal protective equipment (face masks, respirators, visors and protection glasses). In: Associação Portuguesa de Tratamento de Feridas. Porto, Portugal: Largo Eng. Antonio de Almeida;, 2020:8.
41.
ZirwasMJ.Attempting to define “hypoallergenic”. JAMA Dermatol, 2017; 153(11):1093–1094.
42.
XuS, KwaM, LohmanME, et al.Consumer preferences, product characteristics, and potentially allergenic ingredients in best-selling moisturizers. JAMA Dermatol, 2017; 153(11):1099–1105.
43.
American Contact Dermatitis Society. American Contact Dermatitis Society Contact Allergen Program. Available at: https://www.contactderm.org/resources/acds-camp. Published 2020. Accessed April20, 2020.
JiangW, CaoW, LiuQ. Wearing the N95 mask with a plastic handle reduces pressure injury. J Am Acad Dermatol, 2020; 82(6):e191–e192.
46.
StaskoT, BrownMD, CarucciJA, et al.Guidelines for the management of squamous cell carcinoma in organ transplant recipients. Dermatol Surg, 2004; 30(4 Pt 2):642–650.
