Exploration of the Changes in Facial Microbiota of Maskne Patients and Healthy Controls Before and After Wearing Masks Using 16 S rRNA Analysis.

Whether in the field of medical care, or in people's daily life and health protection, the importance of masks has been paid more and more attention. Acne, the most common complication after wearing masks, which is also called maskne, has been successfully introduced into the common language as a common topic of dermatologist consultations. This study aims to study the changes of microflora in maskne patients and healthy controls before and after wearing masks. In the summer of 2023, we collected a total of 50 samples from 15 maskne patients and 10 healthy controls before and after wearing surgical masks for a long time. 16 S ribosomal DNA sequencing and identification technology with V3-V4 variable region were adopted to explore the microbiome changes caused by mask wearing, analyze the changes in microbial diversity, and make interaction network. LDA effect size analysis was used to identify which bacteria showed significant changes in their relative abundance from phylum to genus. After wearing a mask, the microbiome of the maskne patients changed significantly more than that of the healthy controls, with both α diversity and ß diversity lower than those of maskne patients before wearing masks and those of healthy controls after wearing masks. Co-occurrence network analysis showed that compared with other groups, the network of maskne patients after wearing masks for a long time had the lowest connectivity and complexity, but the highest clustering property, while the opposite was true for healthy controls. Many microbes that are potentially beneficial to the skin decreased significantly after wearing a mask. There was almost no difference in healthy controls before and after wearing a mask.

MASKNE - Prevalence and association of causative factors during Covid-19 pandemic at a tertiary care hospital of Karachi.

OBJECTIVE: To assess the prevalence of mask acne in general population and healthcare workers, and the association of acne breakout due to mask-wearing with different factors. METHODS: The prospective, cross-sectional study was conducted from January to April 2022 at the Dermatology Department of Aga Khan University Hospital, Karachi, and comprised patients of both genders of all ages who received acne treatment during the period. Data was collected using a self-designed questionnaire having Cronbach's alpha value 0.789 which was filled by the subjects. Data was analysed using SPSS 19. RESULTS: Result: Of the 200 subjects, 152(76%) were females and 48(24%) were males. The overall mean age was 25.50±8.49 years. There were 122(61%) non-healthcare workers and 76(38%) were healthcare workers. Acne was prevalent in 157(78.5%) participants, and, of them, 123(78.3) were females. Significant association of acne breakout due to mask-wearing was found with regular mask change habit (p<0.001) and past history of acne (p<0.01). Participants who wore mask continuously for 6 hours or more came up with more complaints of acne (p<0.05). CONCLUSIONS: Prolonged and continuous use of the same mask for 6 hours or more could lead to acne eruption.

Risk factors for the development of acne in healthcare workers during the COVID-19 pandemic.

The COVID-19 pandemic has led to many healthcare workers having prolonged contact with tight-fitting masks, leading to maskne. "Maskne" is defined as acne secondary to mask use. There are limited studies on maskne during the COVID-19 pandemic. The objective of this study is to identify risk factors for the development of maskne amongst healthcare workers. A cross-sectional survey was completed by 227 medical students, resident physicians, and nursing students at Johns Hopkins Medicine, with 68.7% of participants reporting development of maskne. Surgical masks and respirators were the most prevalent mask types worn at work. The most common prevention methods were the use of mild cleansers and moisturizers. Chi-squared analysis was used for data analysis. The results of this study indicate that gender (p = 0.003) and duration of mask use (p = 0.048) are significant risk factors for maskne development. These factors are non-modifiable, but may be used for more targeted education for prevention.

Maskne: A side effect of wearing face mask and face mask-wearing attitudes and behavior during 1st, 2nd and 3rd waves of COVID-19 in rural population of Haryana.

Introduction: The term "maskne" originated during the SARS CoV-2 (COVID-19) pandemic; it is a variant of acne associated with continuous wearing of face mask. Maskne is mainly observational, and the most common cause of maskne is contact irritant dermatitis. Materials and methods: The average mask use percentage by OPD cases visiting the hospital for a month in each wave of the COVID -19, that is, in the month of June 2020 during the first wave, in the month of April 2021 during the second wave and in the month of December 2021 during the third wave was calculated. We also included 30 patients with a diagnosis of irritant contact dermatitis aka maskne and 30 patients with diagnosis of acne vulgaris, all >18 years of age from April 2020 to December 2021. Results: 66% of people wore masks coming to hospital in the month of June 2020 (first wave) which increased to 74% during the second wave in the month of April 2021 and during the third wave only 23% of people wore masks in the month of December 2021. Conclusion: Maskne and worsening of acne vulgaris can be due to wearing of dirty face masks for longer duration. Use of moisturizers and regular "mask breaks" are important aspects in management of maskne.

Maskne-Dermatosis of a Pandemic. A Survey on the Impact of PPE on Facial Skin Among HCW and N-HCW in Poland.

INTRODUCTION: During the SARS-CoV-2 pandemic, personal protective equipment (PPE) became the new social norm for preventing COVID-19, but with an impact on the skin barrier. This study aimed to analyze the factors influencing PPE wearing, following hygiene rules, and effect on facial skin, including onset or exacerbation of dermatoses among healthcare workers (HCW) and non-healthcare workers (N-HCW). METHODS: In 2020, an original survey was carried out among 300 N-HCW and 60 HCW with 60 questions about using PPE and skin lesions experienced before and during the pandemic. Cross-sectional statistical analysis was completed to assess the interplay between environmental factors and maskne occurrence. RESULTS: The N-HCW group included 74% females and 26% males with an average age 24.67 ± 0.74. Among HCW respondents 91.7% were women and 8.3% were men, with an average age of 30.07 ± 0.36. All participants used PPE. Volunteers for N-HCW mainly chose a disposable (53.3%) and reusable masks (37.3%), while HCW preferred surgical (66.7%) and FFP2/FFP3/N95 masks (30%) and almost never used reusable masks (3.3%). HCW mainly spent 5-8 h with PPE, and N-HCW spent 1-4 h with PPE/day. Respondents with dermatological problems before the pandemic were more aware of the maskne and paid more attention to hygiene with PPE. Significantly, HCW experienced more severe facial skin lesions than N-HCW (p < 0.0001). There was statistical significance in following the basic hygienic rules of wearing PPE between both groups, where HCW practiced them more. CONCLUSIONS: Maskne is a current and urgent problem to be cured. HCW should receive help if they develop maskne, such as limited time spent in PPE and treatment of the results of wearing it, as it is the main trigger of developing maskne. In addition, education about the correct use and choice of PPE should be improved.

Dermatosis relacionadas indirectamente con la COVID-19 / Dermatoses indirectly related to COVID-19

RESUMEN Introducción: el nuevo coronavirus SARS-CoV-2, agente causal de la COVID-19, fue hallado en Wuhan, China, en diciembre de 2019. Desde entonces, la pandemia generada ha puesto en vilo al mundo, dada su alta contagiosidad y capacidad para dañar los órganos y sus sistemas, incluyendo la piel. Esta se ha visto afectada tanto por la acción directa del virus como por los nuevos estilos de vida que han sido adoptados para evitar el contagio. Objetivo: caracterizar las lesiones cutáneas originadas por los nuevos estilos de vida durante la COVID-19. Materiales y métodos: se realizó un estudio observacional, descriptivo y prospectivo de los pacientes que acudieron a consulta de Dermatología en el Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández, de Matanzas, con lesiones cutáneas de reciente aparición sin causa aparente conocida, entre septiembre de 2020 y febrero de 2021, y que dieron su consentimiento informado para participar en la investigación. El universo estuvo integrado por 14 pacientes portadores de lesiones sin etiología precisada. Todas las lesiones fueron sometidas a examen clínico y algunas, además, fueron tributarias de examen microbiológico. Resultados: predominaron las féminas con un 78,6 %, una media de edad de 34 años y la piel blanca, para un 71,4 %. Las pápulas y pústulas fueron las lesiones de mayor incidencia, siendo más afectados los que usan la mascarilla más de cuatro horas. Los sitios anatómicos más vulnerables fueron el mentón, las mejillas y la zona peribucal. Conclusiones: el maskné y las discromías postinflamatorias son enfermedades que se atribuyen en la actualidad al uso continuo del nasobuco.

ABSTRACT Introduction: the new SARS-CoV-2 virus, causal agent of COVID-19, was found in Wuhan, China, in December 2019. Since then, the pandemics generated has put the world in suspense, given its high contagiousness and capability to damage the organs and their systems, including the skin. The skin has been affected both by the direct action of the virus and by the new life styles that have been adopted to avoid contagion. Objective: to characterize the lesion skins originated by the new life styles adopted during the COVID-19 pandemics. Materials and methods: an observational, descriptive and prospective study was carried out with the patients who assisted the consultation of Dermatology in the Clinical-surgical Teaching Hospital Faustino Perez Hernandez, from Matanzas, with skin lesions recently appeared with apparently unknown cause, between September 2020 and February 2021, and who gave their informed consent to participate in the research. The universe was formed by 14 patients bearing lesions without precise etiology. All lesions undergone clinical examination and some of them also underwent microbiological examination. Results: females predominated with 78.6 %, aged an average 34 years and white skin with for 71.4 %. Papules and pustules were the lesions of higher incidence, being the most affected those who wear masks for more than four hours. The most vulnerable anatomic sites were the chin, cheeks and peribuccal area. Conclusions: maskne and post-inflammatory dyscromies are diseases that are currently attributed to the continued use of face masks.

Efficacy and safety of a facial serum containing snail secretion filtrate, Calendula officinalis, and Glycyrrhiza glaba root extract in the treatment of maskne: A randomized placebo-controlled study.

INTRODUCTION: During the ongoing COVID-19 outbreak, face mask use has increased and became a part of our daily lives. While wearing, prolonged contact time and microenvironmental change profoundly lead to an acne flare-up, defined as "maskne." AIMS: We aimed to assess the efficacy and safety of snail secretion filtrate, Calendula officinalis, and Glycyrrhiza glaba root extract combination serum (SCGS) in treating the maskne. METHODS: This was a randomized, double-blind, placebo-controlled trial study. This study enrolled 66 participants with mild-to-moderate maskne. The SCGS and placebo were randomly assigned for participants to use twice daily for 12 weeks. Percentage change of acne lesion count, acne severity by Investigator Global Evaluation Acne (IGEA), sebum levels, corneometry levels, transepidermal water loss (TEWL), erythema score by Visia®, and adverse events were evaluated 4-weekly at baseline to Week 12. At Week 12, all participants evaluated their satisfaction scores using a 10-point visual analog scale (VAS). RESULTS: In the mask-covered area, the percent reduction in inflammatory acne lesions from the treatment group was significantly greater than the placebo group at all time points (coefficient of percentage change of inflammatory lesions = -33.89 [95% CI -65.24, -2.53]; p = 0.03). Also, a subgroup analysis with participants using concurrent acne treatments revealed similar results (12 participants, coefficient = -50.30 [95% -88.65, -11.95]; p = 0.01). However, there were no significant differences in non-inflammatory lesions, all skin biophysics, and VAS between groups. Adverse events were mild and occurred in a few cases in both groups. CONCLUSIONS: The SCGS could significantly improve inflammatory acne lesions and had a favorable tolerability profile, suggesting its role as an adjunctive treatment in maskne.

The development of acne vulgaris due to face masks during the pandemic, risk awareness and attitudes of a group of university students.

BACKGROUND: Recent work conducted with healthcare workers and middle-aged populations has recognized the association between acne vulgaris (AV) and mask-wearing. OBJECTIVE: This study aimed to evaluate the correlation between the face mask and AV in a group of university students, triggering factors, the awareness, and attitudes of the students. METHODS: A face-to-face survey was conducted to 200 participants (84 males, 116 females) who composed of third- and fifth-grade medical faculty students. The questionnaire compiled the demographic data, skin care habits, mask-wearing habits, skin lesions developed on their faces with the use of face masks, awareness, and attitudes of the students. RESULTS: The mean age of the participants was 21.39 ± 1.34 (range, 19-26 years). While 40.5% of the students developed new AV, 20.5% had exacerbation of their old AV. Lesions developed most frequently in the cheek (51%) and chin (45.5%) regions. During the COVID-19 pandemic, being female (p = 0.04), prolonged masks use (p = 0.001), and fewer mask changes throughout the day (p = 0.01) were found to be associated with the development of AV. Moreover, 90.5% of students stated that the face mask could cause the development of AV. The most frequent protective precautions of the students were the intermittent removal of face masks and regular handwashing. CONCLUSION: The use of face masks triggers the development of AV in young people. Wearing masks over long periods of time without breaks and infrequently changing one's mask throughout the day may lead to the development of new or worsening of AV in young populations.

Maskne: The Epidemic within the Pandemic: From Diagnosis to Therapy.

Maskne, a newly coined term deriving from the contraction of mask-related acne, is a form of mechanical acne resulting from continuous textile-skin adherence and friction. Prolonged mask use heats up the face environment, thus modifying skin microbiota and sebum production. Although effective prevalence is unknown, since the pandemic began and the prolonged use of masks was extended to the general population, maskne has been a frequent topic of consultation among dermatologists. This term has been successfully introduced into common language, with more than 200,000 hashtags on social media, where it is also possible to find "home remedies" that can worsen this dermatosis. The aim of this paper is to discuss the pathogenesis, address clinicians on the correct differential diagnoses among facial dermatoses, and move towards the correct therapy.

Comparison of Malassezia Colonization of 'Maskne' Patients with Seborrheic Dermatitis Cases and Healthy Individuals.

Background: With the Covid-19 pandemic, the use of masks has increased the frequency of 'maskne' cases. Local physiological changes due to the use of mask have caused changes in the presence of yeasts in the environment, such as acne and seborrheic dermatitis. Objectives: The aim is to compare the differences of Malassezia species in the maskne region. Materials and Method: A total of 408 subjects wearing masks at least 4 h a day for 6 weeks or longer, compromised of 212 acne patients, 72 seborrheic dermatitis sufferers, and 124 healthy volunteers were included in this study. Swab samples were taken for Malassezia cultures from nasolabial area and their control retro auricular region. The Statistical Package for Social Sciences (SPSS) version 22 was used for the statistical analysis. Results: Malassezia species was most frequently found in the nasolabial region of the seborrheic dermatitis group. Malassezia species were more commonly isolated from the nasolabial region of acne and seborrheic dermatitis patients, compared to the retroauricular region of each patient, than the healthy subjects. The rate of M. globosa isolated from the nasolabial region was high in all groups, the isolation rate of M. restricta was low (P < 0.05). Conclusion: As Malassezia species are more commonly isolated from the nasolabial region of acne and seborrheic dermatitis patients, the increasing numbers of Malassezia species will trigger inflammation with an antibody reaction against these yeasts. Treatment of resistant acne and seborrheic dermatitis will be facilitated with the knowledge of this inflammation.

Maskne: A New Acne Variant in Covid-19 Era.

"Maskne" has been one of the negative spinoffs of the universally acceptable and effective role of face mask in containing the ongoing pandemic of SARS-CoV-2 virus or COVID 19. Several factors contribute to its aetiopathogenesis including heat, humidity, mechanical friction and microbiome dysbiosis in a complex interplay under the occlusive area of the mask. Clinically, the morphology is not very different from acne vulgaris with comedones and inflammatory acne, but in a characteristic distribution over a roughly circular area of face covered by mask. Since the use of face masks is likely to continue in the near future, measures like wearing a comfortably fitting mask of appropriate fabric, using disposable masks, increasing mask-free period when at safer places, avoiding unnecessary use of personal care products over the occluded skin, proper and gentle cleaning of the affected areas, intermittent mopping off of the excessive sebum and sweat and use of specific, topical and systemic therapy could help in its resolution.

Perioral dermatitis: Diagnosis, proposed etiologies, and management.

BACKGROUND AND AIMS: Perioral dermatitis is a common cutaneous condition characterized by acneiform facial eruptions often with an eczematous appearance. A granulomatous subtype exists in addition to the classic variant. While topical corticosteroids have been largely implicated in this condition, its etiology is not completely understood. METHODS: Using the keywords "corticosteroids," "dermatology," "fusobacteria," "perioral dermatitis," and "periorificial dermatitis," we searched the databases PubMed, MEDLINE, and EMBASE to find the relevant literature. Only articles in English were chosen. The level of evidence was evaluated and selected according to the highest level working our way downwards using the Oxford Centre of Evidence-Based Medicine 2011 guidance. RESULTS: This systematic review found the strongest evidence to support topical corticosteroid misuse as the principal causative factor in the pathogenesis of perioral dermatitis. CONCLUSION: In terms of treatment, further research is required to robustly investigate promising treatment options including tetracyclines, topical metronidazole, topical azelaic acid, adapalene gel, and oral isotretinoin.

COVID-19 related masks increase severity of both acne (maskne) and rosacea (mask rosacea): Multi-center, real-life, telemedical, and observational prospective study.

Masks are essential for COVID-19 prevention, but recently they were suggested to modify cutaneous facial microenvironment and trigger facial dermatoses. To evaluate mask-related rosacea and acne (maskne) in untreated patients during lockdown. In this multi-center, real-life, observational prospective study, we enrolled stable, untreated acne and rosacea patients that wore masks during lockdown at least 6 h/day. They underwent two teledermatological consultations, at the baseline and after 6 weeks. Clinical, pharmacological, and psychological data were recorded. A total 66 patients, 30 (median age: 34.0 [30.25-29.75] yoa) with acne and 36 patients (median age: 48 [43-54] years) with rosacea, were enrolled in this study. After 6 weeks of mask and quarantine, patients with acne displayed an increased Global Acne Grading Scale (GAGS) score in mask-related areas (P < .0001). Likewise, after 6 weeks of mask and quarantine, patients with rosacea displayed a worsen in both physican (P < .0001) and patient (P < .0001) reported outcomes. Remarkably, patients reported also a statistically significant decrease in their quality of life (P < .0001). Masks appear to trigger both acne and rosacea flares. Additional studies are needed to generate evidence and inform clinical decision-making.

"COVID" Terminology in Dermatology.

Ever since the beginning of COVID-19 pandemic, mucocutaneous manifestations started being noticed and are still being documented. Many of these have been described with the prefix "COVID" and may occur due to the infection (e.g., COVID rash), use of personal protective equipment in healthcare workers (e.g., COVID hand dermatitis) or extensive use of novel vaccines (e.g., COVID arm). This article attempts to summarize such entities with clinical relevance to dermatologists and physicians in general and to create awareness about this fast-evolving COVID lexicon.

Facial Mask-related Acne and Acneiform Eruption During the Coronavirus Disease 2019 Pandemic: A Case Series.

Use of a facial mask is a necessity during the current pandemic. The associated occlusion with extended daily use can lead to physiological changes in the skin with resultant irritation, itching, and infections. This can lead to exacerbation of pre-existing dermatoses or induction of irritant dermatitis or bacterial folliculitis. We observed several patients with previously controlled acne vulgaris who developed a flare. Also, in those without a history of pre-existing acne, an acneiform eruption was noted. The majority of patients were women who had pre-existing acne and needed to wear a N95 respirator or a surgical mask for several hours a day, every day. A few suggested simple preventative measures provided herein might help this vulnerable population.