Anti-COVID-19 Face Masks and Perioral Dermatitis

Dear Editor:

Perioral dermatitis (POD) is a papular-vesicular-pustular disease, with a chronic clinical course, of the perioral area. It occurs mainly in middle-aged females. It is often caused by topical corticosteroids, although cosmetics and toothpastes containing chlorine or fluorine may sometimes be responsible for the disease. To our knowledge, only two articles have been published about POD associated with or caused by anti-COVID-19 face masks.1,2 We present the results of a study carried out in the metropolitan area of Milan, Italy, on POD before and during COVID-19 pandemic. In the period October–December 2019, we observed an average of 14 patients per month with POD. From May 2020 to December 2021 we observed an average of 24 patients per month with POD; however, from October to December 2021, the average was 32 patients per month, i.e., more than twice in comparison with the period October–December 2019. All patients were females, except one male, who wore an anti-COVID-19 face mask for 6 to 12 hours per day. There were no differences about the type of face masks (surgical or cloth or N95 masks). It is worthy of note that approximately 25 percent of these patients were not affected by POD before the COVID-19 pandemic: anti-COVID-19 face mask can therefore be considered as a predisposing factor for POD. Furthermore, in our patients POD was observed almost exclusively in the skin underneath the masks. Face masks induce an increase of the temperature of the face, with subsequent abnormalities of microbiota (proliferation of Staphylococcus epidermidis and/or Fusobacteria spp. and/or Demodex folliculorum) and permeability of skin barrier.3 In conclusion, POD is an additional dermatitis of the face that, like acne, rosacea, and seborrheic dermatitis, can be caused or worsened by the frequent use of anti-COVID-19 face masks.2,4,5