“I’m now a dermatologist and a patient at the same time,” he says.
While he isn’t seeing many patients in person — only urgent cases — he’s still around his co-workers all day, so the mask must stay on. “These masks are super uncomfortable,” he says.
Skin irritation from wearing personal protective equipment is a hazard already familiar to health-care providers working in settings where infection control is critical. Now it has also become familiar to many people wearing masks in public, and frequently washing their hands. (Even bandannas and cloth masks, different from medical masks, can cause reactions, depending on the cloth, dyes and the detergent used to clean them, experts say.)
Friedman applies moisturizer to his face several times a day to decrease friction between his skin and the mask, useful advice for everyone, he says.
“It’s all about the barrier,” he says. “We need to protect our biological armor. This means not overwashing, especially with soap, and applying a moisturizer, preferably a thicker lotion or cream, to damp skin to lock moisture in where it’s needed, and to add an extra layer of protection from all the nasty things out there.”
The Centers for Disease Control and Prevention recommends that everyone wear face masks or cloth coverings over the mouth and nose when in public, especially where social distancing may be difficult, so it’s probably wise to take steps to protect the skin to prevent or alleviate problems.
“I think we will be wearing masks for months to come, given the smoldering nature of this viral pandemic,” Friedman says. “These skin issues, without good preventive and treatment strategies — which we have — will likely persist and become more prevalent.”
Dawn Davis, a dermatologist with the Mayo Clinic, says the skin, which is the body’s largest organ, protects us from the environment but can become damaged when it cannot respond fast enough to stresses.
“The skin is a very active organ of the body, just like any other organ,” she says. “In contrast to many other organs, it continually regenerates and produces its own moisturization. Our skin is very busy on a day-to-day basis on a level we don’t think about. It’s a full-time job.”
She compares skin to beleaguered feet that end up in ill-fitting or too tight shoes.
“The skin compensates by creating calluses,” she says. “The difference between the foot and the hands and face is that the bottom surface of the foot is much thicker than the skin on the backs of hands and on the face, so it doesn’t have the natural mechanism to form a callus. Instead, you get irritation, dryness, friction and dermatitis.”
She suggests using hypoallergenic soaps and washing hands and face in warm — not scalding — water. Pat dry, using linen or cotton, less abrasive than a paper towel. For hands, if moisturizing with cream or lotion alone doesn’t work, she recommends covering the lotion layer with an ointment, like petroleum jelly, then putting cotton socks over the hands overnight.
And if that’s not enough, try what she calls the “skin burrito,” a technique that adds additional moisture. Wash your hands, pat them dry and apply two layers of hypoallergenic lotion or cream. Put a teaspoon of white vinegar into a glass or small bowl of warm water and soak two clean washcloths in the solution. Wring them out, wrap them around your hands and cover them with socks.
The advice is similar for the face. Wash, pat dry and apply hypoallergenic moisturizer — lotion or cream — twice, leaving a thick layer. The vinegar soak works here, too. Lay the wet cloths across the irritated parts of the face for about 15 minutes, three or four times a day.
Davis also likes zinc oxide — which fights inflammation — the same stuff lifeguards put on their noses to prevent sunburn, and parents put on babies’ bottoms to treat diaper rash. Put a thin layer in facial areas where the mask rubs.
It’s also important to remember that broken skin is a portal for infection, and that ignoring skin problems can cause long-lasting, although treatable, skin discoloration, or require prescription medications. Moreover, mask wearing can worsen existing primary skin diseases, such as seborrheic dermatitis, or red scaly skin, rosacea, or red patches and visible blood vessels, eczema, an itchy inflammation, and perioral dermatitis, an acnelike redness around the mouth.
“Many of the masks that people — and myself — have at home are these fairly hard cone masks that can be very irritating from the pressure,” says Brian Kim, a dermatologist and co-director of Center for the Study of Itch and Sensory Disorders at Washington University School of Medicine. “Usually these masks are used very transiently while people are doing housework that creates dust.
“However, during covid-19, people are wearing them all day,” Kim says. “My face had long pressure lines, with redness, soreness, and my face was also very flushed underneath. I also have some mild rosacea, which was getting exacerbated by the heat and humidity and causing my face to get unusually red.”
Karen Ousey, director of the Institute of Skin Integrity and Infection Prevention at the University of Huddersfield in England and the author of a recent paper describing the skin issues among health-care workers, urges them to ensure masks are fitted correctly and aren’t too tight.
Apply moisturizer at least 30 minutes before putting on the mask, to avoid an improper fit, she says. She also warns that paraffin products are flammable, so anyone using them should not smoke. Finally, “if possible and safe to do so,” she says, remove masks every two hours to relieve pressure.
Most of these problems are preventable and easily treated, Friedman says.
“In this unprecedented time, we all need to do our part to protect ourselves and those around us,” he said. “Face masks save lives. Moisturizers save skin. Apply both to your daily routine.”