Introduction
During the COVID-19 pandemic, the medical community has quickly sought methods to reduce rates of transmission. Chief among those is usage of both surgical and non-surgical masks. Patients with atopy may be at risk for adverse reactions to use of such masks.
Case Description
This is a 60-year-old Black man with adult-onset atopic dermatitis (AD) with contact dermatitis (patch testing positive to textile dye mix, carba mix, and thiuram mix), and chronic allergic rhinitis. His AD was well controlled with daily emollient use alone until April 2020, when he presented to our hospital emergency room three times with complaints of a facial rash. He was discharged with prednisone. At follow up telehealth visit in Allergy clinic, he reported the symptoms were ongoing for 2 weeks and involved the infraorbital skin and back of his neck. Patient denied new exposures to known allergens. Further questioning revealed he began wearing a mask for COVID-19 precautions shortly before the rash began. Rash distribution correlated with the elastic-containing components of a non-surgical mask. We tapered prednisone to avoid rebound dermatitis and advised him to use topical steroid and topical tacrolimus until rash resolved. He was instructed to use cotton based, dye-free masks without elastic. At telephone visit 1 week later, he endorsed continued improvement.
Discussion
Common allergens implicated in contact dermatitis, including carbamates and thiurams, are found in masks, elastic bands, and other components of face coverings. It is important to identify those with underlying conditions that may result in certain types of face masks being contraindicated.
