By Bharat Upadhyay

New Delhi, Apr 5 (IANS): Doctors, nurses and healthcare personnel fighting COVID-19 from the front lines have to spend many hours a day wearing face masks. Although it offers invaluable protection, health experts have stressed that sweating and the rubbing of the masks against the nose may lead to significant skin damage.

However, following some simple tips like keeping the skin clean, well-hydrated and moisturised can help one avoid skin damage from face masks, according to a recent study, published in the Journal of Wound Care.

Dermatologist D.M. Mahajan of Indraprastha Apollo Hospitals in New Delhi also said that deeply moisturising the skin is important for people who need to wear masks for a long time.

If possible, take off the mask for a while after maintaining some social distancing and keep changing the mask every 8-9 hours, the doctor said.

"Doctors need to be very cautious as in this profession social distancing is not possible all the time. To avoid getting infected, they have to wear a mask which needs to have adequate tightness. It is very pertinent that there has to be an adequate pressure which can cause a fair amount of pressure on the nasal bridge, surrounding cheek and jawbone," Mahajan told IANS.

Wearing masks for a long time can cause rashes, dryness, acne or pimple formation and dermatitis, the doctor said.

Manjul Agarwal, Senior Consultant, Dermatology, Fortis Hospital in Shalimar Bagh, New Delhi said that surgical face masks and N95 respirator masks when used properly provide adequate protection against infectious diseases transmitted by respiratory droplets.

"Surgical facemasks are commonly made up of polypropylene which is a non woven fabric. Disposable N95 surgical respirators consist of four layers and the innermost layer coming in contact with the skin is also made up of polypropylene," Agarwal said.

"Although polypropylene is considered to be the safest of all plastics, it can cause skin allergies in rare cases, especially if the mask is wet and worn for long hours.

"These masks also have a malleable aluminium nose strip placed for a tighter seal of the nose. This, in turn, can cause allergic contact dermatitis, frictional dermatitis and frictional melanosis over the nose," she told IANS.

According to the doctor, the moisture which collects from exhalation inside the mask especially at body temperature can provide a perfect setting for the bacteria to thrive and may cause infections like folliculitis, especially in men with heavy beards.

Pre-existing dermatoses like acne and fungal infections may also be aggravated due to sweat collection.

"If any occlusive topicals like oil-based moisturisers and makeup are applied prior to the application of masks, they can lead to blockage of skin pores causing sebum accumulation and acne. The tight elastic bands stretching over the ears can cause pain and contact dermatitis in the retroauricular region," Agarwal said.

"Frequent changing of the mask, mask free time in between if possible may be practised to prevent these dermatological adverse effects," she noted.

For people with acne-prone skin, it may be worth avoiding some of the traditional acne treatments such as salicylic acid, benzoyl peroxide, and retinoids as they make the skin further dry or irritable, said Rahul Arora, Associate Consultant Dermatology, Max Super Speciality Hospital in New Delhi.

This effect can be aggravated by the routine use of face masks.

This, however, does not mean that people with sensitive skin cannot wear face masks.

"If they feel that their skin is irritated it can help to use moisturisers that contain ceramides, squalene, niacinamide, or hyaluronic acid that may rehydrate the skin and also serve as a barrier for the skin to protect it," he added.