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When *Nicole takes her mask off after working a 12-hour shift treating COVID-19 patients, she is met not only with exhaustion but a set of skin issues that she's never had to deal with before: pressure marks on her nose, chaffing on her cheeks, and large cystic pimples all over her face.
"My skin is the worst that it's been in the last 10 years," says the Detroit-based registered nurse. "I know it's from constant personal protective equipment (PPE) usage. My hospital currently has about 880 COVID-19 positive patients, and it's wearing us all down."
Nicole is not alone. Viral posts on Instagram and pleas for help on Reddit show that medical staff around the U.S. are experiencing adverse skin effects related to the PPE they must wear while fighting on the front lines of this pandemic.
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"It's a running joke that we are glad no one can see under our masks because of how bad our skin has gotten," says *Stephanie, a Kirkland, Washington-based registered nurse. "I wouldn't change my profession for the world. [But] honestly, I look in the mirror right now and...it's a little heartbreaking. The mask rubs the tip of your nose, your mouth, behind your ears until they are raw, and puts pressure under your eyes. I don't know if the blemishes are from stress or the masks themselves. But either way, it's rampant."
Working as a ventilator nurse, Stephanie explains that all medical staff are required to wear gloves and a single N95 mask at all times. "We are expected to wear the same mask all shift, even between patients at times if the hospital is low-supplied. If we are lucky, we are allowed to switch masks between patients," she says. "The skin problems are...staggering. Wearing that mask all day and sweating and having to reapply it day after day sometimes — everyone is breaking out so badly."
Constant pressure on skin invites these problems
Experts believe that the consistent breakouts are due to the pressure of the N95 masks pushing on the skin for long hours causing these problems. According to the Centers for Disease Control and Prevention (CDC), N95 masks are tight-fitting respirators that reduce the wearer's exposure to at least 95 percent of airborne particles.
Orit Markowitz, a board-certified dermatologist at Mount Sinai Hospital in New York City, says to think of N95 masks as suction cups that completely cover your nose and mouth, in which no air is coming underneath where the opening is. "The very fine capillaries that are providing all of the oxygen, nutrients, and all the things it needs to be healthy [are collapsing]," she says. "In a way, you're suffocating the skin, [so it] then starts to break down."
When under great pressure, masks can cause a great deal of irritation, infection, and, in extreme cases, the development of ulcers, like decubitus ulcers on the skin. Long-wear use also means inviting sweat underneath and around the mask, which can cause a bacterial or fungal infection.
"You're not supposed to touch the mask and you're not supposed to touch your face," Markowitz says. "So you're not moving the masks around and the pressure is creating the problem. They're wearing it for long periods of time, and they're not changing it — because they can't."
Stick to the basics to treat and prevent irritation
N95 masks are next to impossible to come by, with hospitals across the country running out of them and even surgical masks. The only way for medical staff to stay protected is to reuse what they already have.
"We are encouraged to make our masks last for the entire week by keeping it in a paper bag when not in use," says Nicole. "So there is buildup at the nose, which causes discomfort. We have been trying not to make a big deal about it [because] we know most others wish they were back at work."
Medical staff have been proactive in trying to solve these skin problems themselves. Besides turning to social media for advice, they're also getting crafty. *Ashley, a New York City-based nurse, says that she and her colleagues have been using hydrocolloid bandages on pressure points in key areas to prevent skin breakdown.
*Kylee, another New York City-based nurse, likes to use the Cavilon Barrier Film, which is an alcohol-free and hypoallergenic liquid solution known to protect skin from irritation and breakouts. "My coworkers and I have been applying [this] to the bridge of our noses and cheekbones," she says. "It acts as a protective layer between the skin and the friction and pressure caused by the mask." Markowitz agrees and says that when applied properly, this liquid film can reduce the wear and tear on the skin.
Jeremy Brauer, a board-certified dermatologist in New York City, suggests placing a layer of soft gauze or a sterile bandage roll prior to putting the mask back on may alleviate some of the irritation and bruising, as long as you are able to maintain the appropriate seal. Shari Marchbein, a board-certified dermatologist in New York City, also suggests using thin dressings like Duoderm or Mepilex right on the bridge of the nose, as that area of the skin is most sensitive to the added pressure of the N95 masks.
*Sophie, a Denver-based registered nurse, was on her first day of seeing COVID-19-positive patients when she already noticed some skin breakdown across the top of her nose and behind her ears. She says some colleagues have been trying to attach the bands of their mask to their hair bouffants, but because the masks have to have a perfect seal they'll likely be tight on the skin no matter how crafty they get.
The best advice Markowitz can give for those experiencing skin concerns as they are working is to go back to the basics: Wash your face with soap and water, moisturize, and use an ointment. Marchbein agrees and explains that petrolatum-based ointments like Aquaphor and Vaseline soothe irritated skin and act as a protective barrier to prevent further trauma to the skin.
However, those who have complex skin-care routines that treat other concerns such as acne should hold off for the time being, as those ingredients (i.e. retinol, tea tree oil, and benzoyl peroxide) might irritate the skin even further, says Markowitz.
If you are experiencing any sort of infection, Markowitz says to see a dermatologist — or schedule a free virtual appointment with her or another board-certified dermatologist for a consultation — who can prescribe a treatment like steroid patches or antibiotics.
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The beauty community is rallying to help medical staff everywhere
Dermatologists aren't the only ones coming to the aid of medical staff. In an effort to lift everyone's spirits, New York City-based beauty editors have been collecting and facilitating donations of skin-care products and care packages to gift to hospitals across the country, while brands, like Hero Cosmetics, for example, are offering free acne products to those on the front lines.
Industry experts are also using their platforms to bring awareness to the harsh realities health care workers face every day of this pandemic. Makeup artist Sir John, who works with celebrities like Beyoncé and Ashley Graham, has teamed up with fashion designer Michael Costello to gift medical staff much-needed masks and skin-care products from brands such as L'Oréal Paris, Tata Harper, and Dr. Barbara Sturm.
"Beauty is my business," says Sir John. "[Donating] is something I can do easily to get these doctors what they need. We're all going to look back on this and ask, 'What did you do?' We should all be looking to see if we're using our platform for something good."
At the end of the day, it's really a group effort that will get everyone through this. We can help by staying inside to help flatten the curve. The less overwhelmed our hospitals are, the less the medical staff has to worry about. As Sophie puts it: "What must be done is for everyone to stay the eff home!"
*Names have been changed.
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