key: cord-0956105-tmbjmy7e
authors: Cretu, S.; Dascalu, M.; Georgescu, S.R.; Salavastru, C.M.
title: Personal protective equipment use and face acne in health care providers during the COVID‐19 pandemic in Romania: A new occupational acne type?
date: 2021-09-30
journal: J Eur Acad Dermatol Venereol
DOI: 10.1111/jdv.17679
sha: 88e0efb398a2c3d377d51b4b953439285a38e5ca
doc_id: 956105
cord_uid: tmbjmy7e

During the COVID-19 pandemic, acne was a commonly reported adverse reaction to medical face mask use amongst health care providers (HCP). A cross-sectional, online survey applied to HCP was conducted from December 17th 2020 until February 17th 2021. This study was approved by University's Ethical Committee and conducted according to the principles of the Declaration of Helsinki.

behaviours, and participants were grouped into generational birth cohorts, with categories provided by Pew Research: Baby Boomers (1946) (1947) (1948) (1949) (1950) (1951) (1952) (1953) (1954) (1955) (1956) (1957) (1958) (1959) (1960) (1961) (1962) (1963) (1964) , Generation X (1965) (1966) (1967) (1968) (1969) (1970) (1971) (1972) (1973) (1974) (1975) (1976) (1977) (1978) (1979) (1980) , Millennials (1981 Millennials ( -1996 and Generation Z (1997-2012). 9, 10 To analyse the evolution of acne during and after the lockdown, we used an exact McNemar's test which indicated significant differences in the proportion of people with acne between the two time frames, P < 0.001. New lesions or acne worsening were reported by 56.0% of subjects during the state of emergency and by 67.5% in the following 7-9 months. This effect becomes more stringent with younger generations (/ Table 1 ), to the extent that an association between acne worsening, and generation is observed as a long-term effect, as the period of time in which people were required to wear PPE extended -v 2 (3) = 8.308, P = 0.040.

Common facial areas affected were chin (70.1%), cheeks (41.8%), nose (34.3%) and neck (34.3%). The predictive model used for lesions development is highly suggestive for acne occurring on mask-affected areas. Regions concurrently involved in the same subject were cheeks, nose, chin (15.7% of cases) and cheeks, chin, neck (14.2% of cases). Chi-squared tests were run to determine the association between acne and various emotional impacts for the two-time frames. The results showed that acne lesions had the highest emotional impact, compared with the pandemic itself and PPE usage. (Table 2 ). An association between lesion excoriation and acne was observed, v 2 (4) = 49.113, P < 0.001 during the lockdown and v 2 

(4) = 45.030, P < 0.001 after it. Acne in the context of medical face mask usage is a distinct subtype of acne mechanica. Management should consider irritation and decreased skin barrier function, which may increase the risk of side-effects on treatment. 6 In contrast to previous studies, we present an in-depth analysis of acne evolution in subjects for the time frames presented. Our model based on frequency-mining algorithms found that the most frequent co-occurring regions were based on proximity. Limitations of our study include a small cohort, imbalance in genders and generations and absence of clinical evaluation. HCPs in Romania commonly reported acne lesions in the areas covered by medical face masks, more intensely with the increase in the number of months during which PPE use was required to be permanent.

This subtype of acne should be regarded as an occupational disease. More regulatory efforts are needed to prevent it and limit its impact on affected HCP. 

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We thank our colleagues for participating in this research and our research collaborators. The patients in this manuscript have given written informed consent to publication of their case details.

SC, MD and SRG report no conflicts of interest. CMS declares the following, not related to the work: royalties from Springer Nature, consulting fees from Vichy International and support for attending meetings from Leo Pharma.