Lehigh County Health & Medicine Fall/Winter 2020 - 15

L C M E D S O C .O R G

strategies include the use of unscented or sensitive-skin hand soaps,
use of warm instead of hot water, frequent use of hand moisturizers
containing ceramides or petrolatum, and avoiding latex-containing
gloves. More severe cases may need a prescription topical steroid to
reduce inflammation.
Dermatitis secondary to PPE commonly affects the areas covered or
in direct contact with the equipment. Contact or irritant dermatitis
may be caused by rubber mask straps, adhesives, metals, and/or
chemicals used to make the equipment. Affected skin may appear
red and bumpy with associated itching or burning. To prevent or
reduce dermatitis due to masks, an alcohol-free barrier film wipe can
be applied to the skin followed by an adhesive foam dressing. Care
must be taken to ensure proper fit of the mask. A fragrance-free,
hypoallergenic moisturizer may also be applied to the skin directly
in contact with the PPE. This should be done at least an hour in
advance of donning of the PPE to ensure proper protection.
Pressure-related skin injuries have been reported due to the tight-fitting nature of N95 masks and goggles/face shields. Although a tight
seal is imperative to decrease droplet exposure, masks and eyewear
should be fitted and adjusted accordingly to prevent pressure-related
skin changes such as bruising, erosions, or ulcers. Appropriate-fitting
PPE should not cause significant discomfort when donned. It is
recommended that 15-minute breaks every 2 hours be taken during
work hours and when safe to avoid continued pressure on the skin.
Use of a soothing moisturizer every morning and night will aid in
healing any skin damage that may have occurred during work hours.
Use of dressings or emollients should be done with caution to avoid
compromise of the protective nature of the PPE.

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Exacerbations of existing dermatologic conditions have also been
observed during the COVID-19 pandemic including recurrences and
worsening of rosacea and seborrheic dermatitis. Seborrheic dermatitis
is characterized by redness and scaling in the eyebrows, around the
nose, and in the scalp. Rosacea is characterized by pustules and
inflammatory papules (similar to acne) on the cheeks, forehead, and
chin. Increased duration of mask wearing and changes in grooming
during the pandemic can lead to a build-up of moisture, overgrowth
of yeast, and overgrowth of demodex mites resulting in a flare of these
conditions. Treatment strategies for seborrheic dermatitis include the
use of an over-the-counter anti-dandruff shampoo or prescription
topical ketoconazole cream. A mild topical corticosteroid such as
hydrocortisone may also be used. Treatment strategies for rosacea
include topical metronidazole, azelaic acid, sulfur-based products,
and/or ivermectin cream. Prevention strategies include mask breaks
and resumption of pre-pandemic grooming practices.
The cutaneous effects of prolonged use of PPE cannot be ignored.
They are prevalent and will continue to emerge as the pandemic
persists. Although the proper equipment must be worn to protect
one's self and others, the cutaneous adverse effects can be minimized
if identified early and prevention strategies are undertaken.
FALL / WINTER 2020 | Lehigh County Health & Medicine 15


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Lehigh County Health & Medicine Fall/Winter 2020

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https://www.nxtbook.com/hoffmann/LehighCountyHealth_Medicine/LehighCountyHealthMedicineSummer2020
https://www.nxtbook.com/hoffmann/LehighCountyHealth_Medicine/LCHM_Spring20
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https://www.nxtbook.com/hoffmann/LehighCountyHealth_Medicine/LCHM_Fall19
https://www.nxtbook.com/hoffmann/LehighCountyHealth_Medicine/LCHM_Summer19
https://www.nxtbook.com/hoffmann/LehighCountyHealth_Medicine/LCHM_Spring19
https://www.nxtbook.com/hoffmann/LehighCountyHealth_Medicine/LCHM_Winter18
https://www.nxtbook.com/hoffmann/LehighCountyHealth_Medicine/LCHM_Fall18
https://www.nxtbook.com/hoffmann/LehighCountyHealth_Medicine/LCHMSummer18
https://www.nxtbook.com/hoffmann/LehighCountyHealth_Medicine/LCHMSpring18
https://www.nxtbook.com/hoffmann/LehighCountyHealth_Medicine/LCHMWinter2018
https://www.nxtbook.com/hoffmann/LehighCountyHealth_Medicine/LCHMWinter18
https://www.nxtbook.com/hoffmann/LehighCountyHealth_Medicine/Fall2017
https://www.nxtbook.com/hoffmann/LehighCountyHealth_Medicine/LCHMSummer2017
https://www.nxtbook.com/hoffmann/LehighCountyHealth_Medicine/LCHMSpring2017
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