Abstract

Here, we did an observational study to investigate the clinical manifestation and patch test results of patients with facial dermatitis induced by wearing of disposable masks. Korean patients over age 18 with facial dermatitis diagnosed by dermatologists at the Department of Dermatology, Kangnam Sacred Heart Hospital after the outbreak of COVID-19 between January 2020 and July 2020 were included. Clinically, 27 patients whose lesions and symptoms worsened after wearing a mask were set as the mask group, and 70 patients who developed facial dermatitis due to other causes were set as the control group. We recruited and distinguished both groups by questionnaire. Demographic features, clinical manifestations, objective bioengineering measurements (Transepidermal water loss [TEWL] and stratum corneum [SC] hydration), and patch test (Korean standard series) results were analyzed in this study. Among the patients in the mask group, the mean duration of diseases was 6.24 months, while the duration in the control group was 22.87 months (Table I). The distribution of skin lesions was similar in both groups except for the chin area where skin lesions were more frequently observed in the mask group (14.81% [4/27]). Erythema and papules were the most common characteristics of the skin lesions in both groups, however, hyperkeratosis (22.22%, [6/27]) and xerosis (11.11%, [3/27]) were significantly more frequent in the mask group. In patch test results, the mask patch tested positive more frequently to potassium dichromate (25.92%, [7/27]) and 4-tert-butylphenol-formaldehyde resin (PTBP) (14.81%, [4/27]) (Table ll). Positive reactions to N-Isopropyl-N-phenyl-4-phenylenediamine (IPPD) (7.40% [2/27]), formaldehyde 4 (11.11%, [3/27]), and thimerosal (14.81%, [4/27]) were more common in the mask group, but the difference was not statistically significant. Interestingly, these substances are known components of disposable facial masks. In addition, 11 patients in the control group (15.71% [11/70]) had negative reactions to all the items in the patch tests, while only one patient in the mask group did (3.70%, [1/27]). These results would infer that the chemical components of disposable masks and residues of disinfectants or cosmetics can cause allergic and irritant reactions. Further, given the occlusive, humid environment within a facial mask, it can be assumed that these substances could more easily penetrate the skin and cause facial dermatitis. After the COVID-19 pandemic, our living and medical environments have significantly changed and so have the frequency and types of exposure to allergens. Consequently, patch tests are essential for determining the correct diagnosis in patients with facial dermatitis. Our study could be a useful index for determining the causative allergens in patients with facial dermatitis induced by disposable masks.

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