Has the Use of the Mask Exacerbated Rosacea During the Pandemic?

Ilaria Trave; Ilaria Salvi; Emanuele Cozzani; Rebecca  Donadoni; Aurora Parodi

doi:10.5826/dpc.1304a230

Has the Use of the Mask Exacerbated Rosacea During the Pandemic?

Authors

Ilaria Trave Section of Dermatology - Department of Health Sciences, University of Genoa, IRCCS - Ospedale Policlinico San Martino, Genoa, Italy
Ilaria Salvi Section of Dermatology - Department of Health Sciences, University of Genoa, IRCCS - Ospedale Policlinico San Martino, Genoa, Italy
Emanuele Cozzani Section of Dermatology - Department of Health Sciences, University of Genoa, IRCCS - Ospedale Policlinico San Martino, Genoa, Italy
Rebecca Donadoni Section of Dermatology - Department of Health Sciences, University of Genoa, IRCCS - Ospedale Policlinico San Martino, Genoa, Italy
Aurora Parodi Section of Dermatology - Department of Health Sciences, University of Genoa, IRCCS - Ospedale Policlinico San Martino, Genoa, Italy

Keywords:

rosacea, mask, COVID-19, SARS-CoV-2

Abstract

Introduction: During the COVID-19 pandemic, personal protective equipment, particularly face masks, has become an essential requirement to engage in social activities. Several articles reported an increase of recurrences of dermatologic facial diseases (i.e., acne, rosacea) related to mask use.

Objectives: To evaluate the number of recurrences of rosacea related to face mask use.

Methods: This prospective study was conducted on adult patients with a pre-pandemic diagnosis of mild and moderate papulopustular rosacea. All patients had previously achieved either partial or complete remission after a 4-month treatment with ivermectin in 2019. We collected data in two different phases characterized by different intensity of mask use during the pandemic and post-pandemic period. We collected data through clinical assessment of the disease, questionnaires on personal habits and standardized skin surface biopsy to study the Demodex mites count.

Results: We enrolled a total of 30 patients. In the pandemic period, 5/30 patients had a relapse of mild papulopustular rosacea; the Demodex sample resulted positive in 4/5 relapsed patients. In the post-pandemic period, 4/30 patients reported a relapse of mild (3 patients) and moderate papulopustular rosacea (1 patient). At the Demodex exam, 1/4 relapsed patients resulted positive.

Conclusions: We did not find a significant increase in relapses of papulopustular rosacea during the pandemic. An appropriate anti-parasitic treatment may reduce the number of recurrences due to mask use.

References

Niesert AC, Oppel EM, Nellessen T, et al. "Face mask dermatitis" due to compulsory facial masks during the SARS-CoV-2 pandemic: data from 550 health care and non-health care workers in Germany. Eur J Dermatol. 2021;;31(2):199-204. DOI: 10.1684/ejd.2021.4007. PMID: 33814358. PMCID: PMC8356539.

Singh GK, Mitra B, Bhatnagar A, et al. Unusual spurts of rosacea like dermatoses, posing a diagnostic dilemma during covid-19 pandemic: a cross-sectional, observational study from a tertiary care centre. Indian J Dermatol. 2021;66(4):401-404. DOI: 10.4103/ijd.IJD_759_20. PMID: 34759399. PMCID: PMC8530062.

Veraldi S, Angileri L, Barbareschi M. Seborrheic dermatitis and anti-COVID-19 masks. J Cosmet Dermatol. 2020;19:2464-2465.

Desai SR, Kovarik C, Brod B, et al. COVID-19 and personal protective equipment: Treatment and prevention of skin conditions related to the occupational use of personal protective equipment. J Am Acad Dermatol. 2020;83(2):675-677. DOI: 10.1016/j.jaad.2020.05.032. PMID: 32416206. PMCID: PMC7228687.

Cosansu NC, Yuksekal G, Kutlu O, Umaroglu M, Yaldız M, Dikicier BS. The change in the frequency and severity of facial dermatoses and complaints in healthcare workers during the COVID-19. J Cosmet Dermatol. 2022;;21(8):3200-3205. DOI: 10.1111/jocd.15044. PMID: 35509253. PMCID: PMC9347995.

Damiani G, Gironi LC, Grada A, et al. COVID-19 related masks increase severity of both acne (maskne) and rosacea (mask rosacea): Multi-center, real-life, telemedical, and observational prospective study. Dermatol Ther. 2021;34(2):e14848. DOI: 10.1111/dth.14848. PMID: 33533563. PMCID: PMC7995182.

Krolo I, Blazeka M, Merdzo I, Vrtar I, Sabol I, Petric-Vickovic I. Mask-Associated Dry Eye During COVID-19 Pandemic-How Face Masks Contribute to Dry Eye Disease Symptoms. Med Arch. 2021;75(2):144-148. DOI:10.5455/medarh.2021.75.144-148. PMID: 34219875. PMCID: PMC8228562.

Gallo RL, Granstein RD, Kang S, et al. Standard classification and pathophysiology of rosacea: the 2017 update by the National Rosacea Society Expert Committee. J Am Acad Dermatol. 2018;78(1):148-155. DOI: 10.1016/j.jaad.2017.08.037. PMID: 29089180.

Tan J, Liu H, Leyden JJ, Leoni MJ. Reliability of clinician erythema assessment grading scale. J Am Acad Dermatol. 2014;71(4):760-763. DOI: 10.1016/j.jaad.2014.05.044. PMID: 24999270.

Hopkinson D, Moradi Tuchayi S, Alinia H, Feldman SR. Assessment of rosacea severity: A review of evaluation methods used in clinical trials. J Am Acad Dermatol. 2015;73(1):138-143.e4. DOI: 10.1016/j.jaad.2015.02.1121. PMID: 25799418.

Forton F, Seys B. Density of Demodex folliculorum in rosacea: a case-control study using standardized skin-surface biopsy. Br J Dermatol. 1993;128(6):650-659. DOI: 10.1111/j.1365-2133.1993.tb00261.x. PMID: 8338749.

Trave I, Micalizzi C, Cozzani E, Gasparini G, Parodi A. Papulopustular Rosacea Treated with Ivermectin 1% Cream: Remission of the Demodex Mite Infestation Over Time and Evaluation of Clinical Relapses. Dermatol Pract Concept. 2022;12(4):e2022201. DOI: 10.5826/dpc.1204a201. PMID: 36534532. PMCID: PMC9681206.

Trave I, Merlo G, Cozzani E, Parodi A. Real-life experience on effectiveness and tolerability of topical ivermectin in papulopustular rosacea and antiparasitic effect on Demodex mites. Dermatol Ther. 2019;32(6):e13093. DOI: 10.1111/dth.13093. PMID: 31579993.

Sari ARP, Patria YN, Wiguna OR, Soebono H, Febriana SA. Occupational skin dermatoses among health care workers: A review of adverse skin reactions to personal protective equipment. Dermatol Reports. 2022;14(4):9474. DOI: 10.4081/dr.2022.9474. PMID: 36483233. PMCID: PMC9724726.

Daou H, Paradiso M, Hennessy K, Seminario-Vidal L. Rosacea and the Microbiome: A Systematic Review. Dermatol Ther (Heidelb). 2021;11(1):1-12. DOI: 10.1007/s13555-020-00460-1. PMID: 33170492. PMCID: PMC7859152.

Tavassoli S, Wong N, Chan E. Ocular manifestations of rosacea: A clinical review. Clin Exp Ophthalmol. 2021;49(2):104-117. DOI: 10.1111/ceo.13900. PMID: 33403718.

Yan Y, Yao Q, Lu Y, et al. Association Between Demodex Infestation and Ocular Surface Microbiota in Patients with Demodex Blepharitis. Front Med (Lausanne). 2020;7:592759. DOI: 10.3389/fmed.2020.592759. PMID: 33251239. PMCID: PMC7672197.