While wearing a mask has become common now, certain people may suffer from face mask allergy writes Dr Irene Lee Chew Kek
OVER the last few weeks as society has become more conscious of using face masks, I have seen a few patients experiencing facial rashes - exactly below the face mask while the rest of the face is spared.
Face mask allergy is not common but can happen. It was documented during the SARS pandemic in 2002-2004.
This is due to the increased usage of face masks and also the prolonged usage of face masks. It has also been categorised as part of the occupational hazard for healthcare workers.
How does one present with face mask allergy or face mask associated rash?
There are a few types of presentation:
1. Contact allergy
The surge that I have seen in my clinic over the last few weeks has been from patients who already have sensitive skin who showed up with a skin allergy right under the area of contact with the face mask. Usually the rashes do not extend beyond the margin of the face mask. The rash is red, scaly, dry and itchy. This condition may worsen without treatment causing discharge and infection on top of the allergy.
There is also a subgroup of patients who don’t have sensitive skin. For them, this contact allergy could be due to the substance used in the production of the face mask. For example, formaldehyde and quaternium-15 have been found in some face masks that cause allergy. On top of that, sometimes, adhesives are used to attach foam into parts of the face mask.
In these instances, dibromodicyanobutane may cause the allergy. Some masks have elastic straps to hold it to the face of the patient. Some patients may be allergic to thiuram, which is used in the production of some of these elastic bands.
2. Occlusive acne
This was also documented during the SARS pandemic when healthcare workers needed to wear face masks for a prolonged period of time. Patients may present with red bumps on the face - with or without pus together with black and whiteheads. These lesions are worse over the area below the face mask. Besides the occlusion causing the acne, some substances in the face mask can also contribute to this.
3. Contact urticaria
In this condition, patients develop hives not long after contact with the face mask. This is rare but a possibility with face mask allergy.
4. Exacerbation of previous face allergy
In patients with pre-existing face allergy, the friction caused by the face mask as well as the increase in temperature below the face mask may aggravate the allergy. This is also something quite commonly seen in my clinic.
Will the type of mask matter with face mask allergy?
Definitely so. Different manufacturers use different ingredients for production. Being allergic to one type does not equate to an allergy to all face masks. If you do have an allergy to your current face mask, treat your face allergy first before attempting to try another type of face mask. In the meantime, practise social distancing and frequent hand washing.
What should I do if I develop a face mask associated rash?
Firstly, only use the mask if necessary. The current recommendation is to practise social distancing and frequent hand washing. Only wear masks if you are sick. Moisturise the rash as frequently as needed and use a gentle cleanser. Do not scratch or rub the rash. Do try to avoid heat exposure. Failing these, seek medical advice. If you are sick and need the mask, also moisturise the rash as frequently as needed and seek medical advice.
How would doctors treat these rashes?
A gentle cleanser and suitable moisturiser is part of the treatment. On top of that, non steroid anti-inflammatory creams and steroid creams may be used to calm down the contact allergy or face allergy. Anti-histamine may be needed for itch control. For acne, if avoidance does not help, anti-acne preparation such as creams or tablets may be needed. Rarely, other treatment may be needed for more severe cases.
In summary, albeit rare, face mask associated rash is a possible risk for people who use face masks. Correct diagnosis and care is important to prevent complications as a result of these rashes.
*The writer is a consultant dermatologist.