Secondary pyoderma arising from prolonged cloth face mask use: A rare adverse skin reaction in a factory worker during the COVID-19 pandemic

• Published in: Clinical medicine (London, England) Vol. 24; p. 100072
• Main Authors: Kanakath, Sanvi, Pulimootil, Davis Thomas, Joy, Sneha Mary, Joseph, Neenu Anna
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01-04-2024
• ISSN: 1470-2118
• DOI: 10.1016/j.clinme.2024.100072

The COVID-19 pandemic prompted the widespread use of face-masks among the general population and healthcare workers to mitigate virus transmission. While masks are crucial for infection control, extended usage may lead to various skin complications. Masks cover body areas close to the mouth, nose and ear creating severely moist and warm local skin environment which changes the natural skin milieu considerably of perioral and perinasal areas. It also increases redness, pH-value, fluid loss through the skin epithelium, increased hydration and sebum production measurably.1 Dermatological side effects in adults due to chronic cloth mask use like generalised or localised maculopapular eruptions, urticaria, pseudochilblain and acro-ischaemic lesions, varicelliform rash, livedoid lesions, erythema multiforme-like vasculitis, herpes lesions, purpuric lesions, acute generalised exanthematous pustulosis (AGEP)-like rash are very common.2,3Acne, contact eczema and urticaria associated with hypersensitivities to ingredients of the masks such as formaldehyde (ingredient in textile) and thiram (ingredient in ear bands) are highly hazardous. Pyoderma, a bacterial skin infection characterised by fleshy growths, is an unusual manifestation related to prolonged mask wear. Being one of the commonest clinical conditions in dermatological practice, with higher incidence amongst lower socio-economic class, it show response to correct antibiotic policy and hygiene practices.
We present a case of a female factory-worker known for chronic cloth-mask use amidst the COVID-19 pandemic, with response to antibiotics, of pyoderma infection in supra-auricular area and the case has not been previously documented and is relevant to the COVID-19 pandemic era.
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A 50 year old female factory worker reported consistent and prolonged usage of a cloth face-mask for the past 6 months during work hours. Examination revealed fleshy growths seen in Fig. 1. No history of similar dermatological issues was reported previously. Physical examination findings, along with the patient's occupational history and prolonged mask use, led to the diagnosis of pyoderma secondary to extended cloth face mask use.
While mask-wearing remains pivotal in controlling the spread of infectious diseases, healthcare providers and the public should be vigilant regarding potential dermatological complications.
In many multicentre studies, duration of wearing masks was identified as the most important factor for the development of adverse effects where people who wear masks for >6 h per day tend to have more adverse skin reaction. Other factors include skin characteristics like skin temperature, hydration, transepidermal water loss (TEWL), and sebum secretion. Whether these factors are the direct consequences of mask-related skin problems have not been confirmed. Pyoderma, a rare occurrence linked to extended mask use, underscores the importance of adequate mask hygiene, regular breaks, and consideration of alternative mask materials or designs for prolonged usage and appropriate antibiotic policy.
The rarity of the case merits attention and highlights the need for healthcare professionals and individuals to recognise and manage potential adverse skin reactions associated with prolonged cloth face mask use. Further research and awareness are essential to address and mitigate rare but possible complications arising from prolonged mask wear during the ongoing pandemic.