Patch Tests 'Essential' in Patients Who Develop Facial Dermatitis From Face Masks

By Reuters Staff

June 28, 2021

NEW YORK (Reuters Health) - The chemical components of disposable facemasks and residues of disinfectants or cosmetics can cause allergic and irritant skin reactions - and patch tests are key to making the correct diagnosis, say clinicians from South Korea.

Dr. Hye One Kim and colleagues from the dermatology department at Kangnam Sacred Heart Hospital in Seoul did a case-control study of adults diagnosed with facial dermatitis after the COVID-19 outbreak.

Participants included 27 patients whose lesions and symptoms worsened after wearing a disposable mask (mask group) and 70 control patients who developed facial dermatitis due to other causes.

Patients in the control group had clinical dermatitis symptoms for significantly longer than patients in the mask group (mean duration, 22.87 months vs. 6.24 months), the researchers report in the Journal of the American Academy of Dermatology.

The distribution of skin lesions was similar in both groups except for the chin area where skin lesions were more frequently observed in the mask group (14.8%) than the control group (5.7%).

Erythema and papules were the most common characteristics of the skin lesions in both groups. However, hyperkeratosis (22.2%) and xerosis (11.1%) were significantly more frequent in the mask group than the control group (4.3% and 1.4%, respectively).

Turning to patch test results, the mask patch tested positive more often to potassium dichromate (25.9%) and 4-tert-butylphenol-formaldehyde resin (14.8%).

Positive reactions to N-isopropyl-N-phenyl-4-phenylenediamine (7.4%), formaldehyde (11.1%) and thimerosal (14.8%) were also more common in the mask group, but the difference was not statistically significant. "Interestingly, these substances are known components of disposable facial masks," the authors say.

In addition, 11 patients in the control group (15.7%) had negative reactions to all the items in the patch tests, while only one patient in the mask group did (3.7%).

"These results would infer that the chemical components of disposable masks and residues of disinfectants or cosmetics can cause allergic and irritant reactions. Further, given the occlusive, humid environment within a facial mask, it can be assumed that these substances could more easily penetrate the skin and cause facial dermatitis," Dr. Kim and colleagues say.

"After the COVID-19 pandemic, our living and medical environments have significantly changed and so have the frequency and types of exposure to allergens. Consequently, patch test results are essential in determining the correct diagnosis in patients with facial dermatitis. Our study could be a useful index for determining the causative allergens in patients with facial dermatitis induced by disposable masks," they conclude.

SOURCE: https://bit.ly/3qAmLg5 Journal of the American Academy of Dermatology, online June 14, 2021.

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