Occupational dermatitis to facial personal protective equipment in health care workers: A systematic review

J Am Acad Dermatol. 2021 Feb;84(2):486-494. doi: 10.1016/j.jaad.2020.09.074. Epub 2020 Oct 1.

Abstract

Background: Prolonged wear of facial protective equipment can lead to occupational dermatoses.

Objective: To identify important causes of occupational dermatoses from facial protective equipment.

Methods: A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed using PubMed and Embase databases. Articles were included if they reported occupational dermatoses caused by surgical/procedure masks or N95 respirators, or both.

Results: We identified 344 articles, and 16 were suitable for inclusion in this review. Selected articles focused on facial occupational dermatoses in health care workers. Allergic contact dermatitis to the elastic straps, glue, and formaldehyde released from the mask fabric was reported. Irritant contact dermatitis was common on the cheeks and nasal bridge due to pressure and friction. Irritant dermatitis was associated with personal history of atopic dermatitis and prolonged mask wear (>6 hours). Acneiform eruption was reported due to prolonged wear and occlusion. Contact urticaria was rare.

Limitations: Only publications listed in PubMed or Embase were included. Most publications were case reports and retrospective studies.

Conclusion: This systematic review from members of the American Contact Dermatitis Society highlights cases of occupational dermatitis to facial protective equipment, including potential offending allergens. This work may help in the diagnosis and treatment of health care workers with facial occupational dermatitis.

Keywords: N95; N95 mask; N95 respirator; acne; allergic contact dermatitis; contact dermatitis; contact urticaria; face mask; irritant contact dermatitis; mask; medical face mask; occupational dermatitis; occupational dermatoses; personal protective equipment; procedure mask; respirator; surgical mask; systematic review.

Publication types

  • Systematic Review

MeSH terms

  • Allergens / adverse effects
  • Allergens / immunology
  • Dermatitis, Allergic Contact / diagnosis
  • Dermatitis, Allergic Contact / epidemiology
  • Dermatitis, Allergic Contact / etiology
  • Dermatitis, Irritant / diagnosis
  • Dermatitis, Irritant / epidemiology
  • Dermatitis, Irritant / etiology
  • Dermatitis, Occupational / diagnosis
  • Dermatitis, Occupational / epidemiology*
  • Dermatitis, Occupational / etiology
  • Dermatitis, Occupational / therapy
  • Facial Dermatoses / diagnosis
  • Facial Dermatoses / epidemiology*
  • Facial Dermatoses / etiology
  • Facial Dermatoses / therapy
  • Health Personnel / statistics & numerical data*
  • Humans
  • Infectious Disease Transmission, Patient-to-Professional / prevention & control
  • Masks / adverse effects*
  • N95 Respirators / adverse effects*

Substances

  • Allergens