Table II.
Unique publications identified
| Publication | Study type | Level of evidence∗ | Exposure | Clinical description | Patch test results | Final diagnosis |
|---|---|---|---|---|---|---|
| A review of nonglove PPE-related occupational dermatoses reported to EPIDERM between 1993 and 20135 | Retrospective cohort | 3 | Face masks, safety glasses | 13 cases of work-related dermatoses reported to EPIDERM in the United Kingdom were from face masks/safety glasses. 4-ACD, 1-ICD, 2-friction, 2-occlusion, 4-acne |
Of the 4 cases of ACD to face masks: 2 caused by N-isopropyl- N′- phenyl paraphenylenediamine 1 caused by nickel 1 unknown (details NR) |
Allergic contact dermatitis Irritant contact dermatitis Acne |
| Adverse skin reactions among HCWs during the COVID-2019 outbreak: a survey in Wuhan and its surrounding regions6 | Cross-sectional survey | 4 | N95 respirator, surgical masks, double gloves | 280/376 (74.5%) of HCW in Wuhan, China, and surrounding regions during COVID-19 had adverse skin reaction: hands > cheeks > nasal bridge. Most common reactions dryness or scale > papules or erythema > maceration. More severely affected regions/hospitals had more cases likely due to longer hours and stringent PPE requirements. >6 hours of PPE had statistically significant increase in adverse skin reactions. |
None | Adverse skin reactions were common. Dermatologic diagnoses were not specified. |
| Skin damage among HCW managing COVID-197 | Cross-sectional survey | 4 | Goggles, N95 respirator | 526/542 (97%) HCWs in COVID-19 pandemic in Hubei, China, reported skin damage. Nasal bridge was most commonly affected area (83.1%); also hands, cheeks, forehead. 70.3% reported dryness and tightness; 61.6% desquamation. >6 hours of PPE wear increased risk of skin damage. |
None | Skin damage. Specific dermatologic diagnosis was not discussed. |
| Adverse skin reactions to PPE against SARS—a descriptive study in Singapore1 | Cross-sectional survey | 4 | N95 respirator, surgical & paper masks; gloves; gowns | 340 HCWs in 2003 SARS epidemic, Singapore. N95 worn on average 8 h/d. N95 respirators: 109/307 (35.5%) had adverse skin reactions: acne (59.6%), facial itch (51.4%), rash (35.8%). Surgical and paper masks: no skin reactions. |
None | Adverse skin reaction to N95 respirator in 35.5%: acne, facial itch, rash. |
| Skin reactions after use of N95 facial masks8 | Case series (abstract) | 4 | N95 respirator | 13 referrals for possible N95 face mask allergy during 2002 SARS epidemic. 5 patients with facial dermatitis, 3 patients with facial urticaria, 2 patients with acute respiratory complaints and no skin changes. |
8 patients completed patch testing, 6 were negative. 2 patients had positive patch test reactions to quaternium-15 and ethylene urea melamine. One of those 2 patients also tested positive for formaldehyde† |
Majority of N95 respirator reactions are ICD. 3 cases of contact urticaria. 2 cases of ACD. |
| Self-report of occupational-related contact dermatitis: prevalence and risk factors among HCWs in Gondar town, Northwest Ethiopia, 2018, a cross-sectional study9 | Cross sectional survey | 4 | Gloves, “PPE,” not otherwise described | 133/422 (31.5%) of HCWs self-reported work-related contact dermatitis in the previous 12 months. 19/422 (5%) reported facial contact dermatitis. |
None | Occupational contact dermatitis, type not specified. |
| Safety equipment: when protection becomes a problem10 | Cross-sectional study | 4 | Safety equipment (masks and respirators) | 88/38533 (0.2%) NACDG patients (2001-2017) had ACD or ICD to safety equipment. 30% were HCWs. Common sites of skin disease were face (28%), hands (17%), arms (13%). |
Most common positive patch test reactions: carba mix, 25.3%; thiuram mix, 22.9%; mixed dialkyl thioureas, 10.8%; nickel sulfate, 8.4%; p-phenylenediamine, 4.8%. | Safety equipment (eg, masks and respirators) is associated with ACD (77%), ICD (28.7%), or both (11.3%). Unknown whether facial dermatitis cases were due to masks. |
| Occupational skin diseases among dental nurses11 | Cross-sectional survey | 4 | Gloves, paper mask | 56/799 (7%) female dental nurses in Finland had facial dermatitis related to dental occupation. History of atopy was significantly associated with facial dermatitis (P < .001) |
Patch testing completed; no ACD identified in patients with facial dermatitis. | Paper face mask was the most commonly reported source of facial dermatitis and caused “slight skin irritation.” |
| Occupational health problems among dental hygienists12 | Cross-sectional survey | 4 | Dental mask | 70/189 (37%) of occupational dermatoses in dental hygienists were skin related. 5/70 had skin-related occupational dermatitis due to face masks | None | Facial dermatitis. Mentions residual formaldehyde causing problems. Some reactions were general allergy or atopy or were not specified |
| The dental face mask—the most common cause of work-related face dermatitis in dental nurses13 | Case report | 5 | Dental mask | 28-year-old female dental nurse with facial & hand dermatitis. | 1+ nickel and cobalt. Mask contained only aluminum via analysis. |
ICD from dental mask in setting of atopic diathesis. |
| Allergic contact dermatitis from formaldehyde textile resins in surgical uniforms and nonwoven textile masks14 | Case report | 5 | N95 respirator, scrubs, disposable paper gown | 49-year-old female physician with recurrent generalized dermatitis during 2003 SARS epidemic. Pruritic eruption of face, neck, flexures, trunk, legs. | 2+ melamine formaldehyde; 1+ urea formaldehyde; 1+ ethyleneurea melamine/formaldehyde mix; 2+ quaternium-15; 1+ toluene sulfonamide formaldehyde resin; 1+ imidazolidinyl urea; 1+ formaldehyde 1%; 1+ MCI/MI Negative patch test to N95 respirator, scrubs, paper gown, but chemical analysis revealed presence of formaldehyde in N95 respirator and scrubs. |
ACD to formaldehyde in N95 respirator and scrubs. |
| Occupational allergic contact dermatitis in an obstetrics and gynecology resident15 | Case report | 5 | Surgical mask, surgical cap | 30-year-old female resident physician with intermittent pruritic eruption on cheeks, eyelids, forehead. | 2+ thiuram; 3+ nickel sulfate; 3+ cobalt; 3+ gold sodium thiosulfate. | ACD to thiuram in elastic of surgical mask and surgical cap. |
| Surgical mask contact dermatitis and epidemiology of contact dermatitis in HCW16 | Case report and review | 5 | Surgical mask | 32-year-old male scrub nurse with intermittent erythematous scaly pruritic rash on face and eyelids. | 1+ carba mix; 2+ dibromodicyanobutane (methyldibromo glutaronitrile); 2+ foam strip from mask. | ACD to dibromodicyanobutane in adhesive used to attach foam strip to textile of surgical mask. |
| N95 acne17 | Case report | 5 | N95 respirator | 2 cases of female health assistants (ages 27 and 45) in Singapore during 2003 SARS epidemic; acneiform eruptions on areas of face covered by N95 respirator. 3 months of N95 wear in hospital. |
None | Acneiform eruptions from N95 respirators. Eruptions cleared with topical retinoid and systemic antimicrobials. |
| Allergic contact dermatitis to face masks in dental clinic: case reports18 | Case reports (abstract) | 5 | Dental face mask | 45-year-old female dentist with erythema, pruritus, edema on perioral face & anterior neck | “Standard patch test” negative (type NR). | Facial contact dermatitis from dental face mask. |
| Dental face mask | 28-year-old female dental resident with burning, edema, erythema & vesicles lips & chin | “Standard patch test” negative (type NR). | Facial contact dermatitis from dental face mask | |||
| Allergic contact dermatitis in dental professionals: effective diagnosis and treatment19 | Case report | 5 | Dental mask | 48-year-old female orthodontic assistant with hand dermatitis and red itchy areas on face. | 1+ carba mix; 1+ quaternium-15; 1+ thiuram mix; 1+ glutaraldehyde; 1+ thimerosal; 1+ MCI/MI | ACD to rubber accelerators (carba mix, thiuram mix) present in dental mask strap, rubber gloves. |
ACD, Allergic contact dermatitis; carba mix, diphenylguanidine, zinc dibutyldithiocarbamate, and zinc diethyldithiocarbamate; COVID, coronavirus disease 2019; HCW, health care worker; ICD, irritant contact dermatitis; MCI, methylchloroisothiazolinone; NR, not reported; MI, methylisothiazolinone; PPE, personal protective equipment; SARS, severe acute respiratory syndrome; thiuram mix, tetramethylthiuram monosulfide, tetraethylthiuram disulfide, tetramethylthiuram disulfide, and dipentamethylenethiuram disulfide.
∗
Key for determination of level of evidence4: 1 = properly powered and conducted randomized clinical trial; systematic review with meta-analysis. 2 = well-designed controlled trial without randomization; prospective comparative cohort trial. 3 = case-control studies; retrospective cohort study. 4 = case series with or without intervention; cross-sectional study. 5 = opinion of respected authorities; case reports.
†
One patient was likely duplicate of this case report: Allergic contact dermatitis from formaldehyde textile resins in surgical uniforms and nonwoven textile masks.