COVID-19: PPE and Its Impact on Skin – What You Need to Know


Healthcare workers (HCW) use a variety of personal protective equipment (PPE) and hygiene practices in their work.  The use increased in the 1980’s with the introduction of universal precautions.  Most of the literature has focused on hand dermatitis related to the use of gloves and hand hygiene.  The SARS pandemic saw some reporting of additional skin problems related to the use of other PPE such as masks, respirators and gowns.  Since SARS there have been a few articles examining skin reactions to PPE.

With the COVID-19 pandemic, it is to be expected that there will be an increase in skin problems related to the increased use of PPE.  Since the onset of COVID-19 there is a growing number of medical publications related to skin problems and use of PPE.

The purpose of this section is to provide a listing of articles relevant to exposure to PPE and skin problems.  It includes the articles that appeared with SARS, some articles that have examined PPE-related skin problems and finally a list of articles related to COVID-19 experience.  It does not contain the extensive literature related to glove use.  A useful reference for hand dermatitis in healthcare workers that reviews glove use and hand hygiene is the recent review by Public Health Ontario: “Recommendations for the Prevention, Detection and Management of Occupational Contact Dermatitis in Health Care Settings”.

We will continue to update the list and add brief summaries of the findings.

SARS literature

Donovan J, Kudla I, Holness DL, et al. Skin reactions following use of N95 facial masks. Dermatitis 2007;18:104.

Donovan J, Skotnicki-Grant S.  Allergic contact dermatitis form formaldehyde textile resins in surgical uniforms and nonwoven textile masks.  Dermatitis 2007;18:40-44.

Foo CCI, Goon ATJ, Leow Y-H, Goh C-L.  Adverse skin reactions to personal protective equipment against severe acute respiratory syndrome – a descriptive study in Singapore.  Contact Dermatitis 2006;55:291-294.

Literature exploring skin reaction to non-glove PPE

Case reports

Al Badri FM.  Surgical mask contact dermatitis and epidemiology of contact dermatitis in healthcare workers.  Curr All Clin Immun 2017;30:183-188.

Kanerva L, Alanko K, Jolanki R, Kanervo K, Susitaival P, Estlander T. The dental face mask – the most common cause of work-related face dermatitis in dental nurses. Contact Dermatitis 2001; 44:261-262.

Kosann MK, Brancaccio R, Cohen D. Occupational allergic contact dermatitis in an obstetrics and gynecology resident. Dermatitis 2003;14(4):217–218.

Reviews of patch test clinic or reporting systems

Alanko K, Susitaival P, Jolanki R, Kanerva L.  Occupational skin diseases among dental nurses.  Contact Dermatitis 2004;50:77-82.

Bhoyrul B, Lecamwasam K, Wilkinson M, et al. A review of non-glove personal protective equipment-related occupational dermatoses reported to EPIDERM between 1993 and 2013. Contact Dermatitis 2019;80:217-222.

Warshaw EM, Schlarbaum JP, Silverberg JI, et al.  Safety equipment: when protection becomes a problem.  Contact Dermatitis. 2019;81:130-132.

COVID-19 related


Bhatia R, Sindhuja T, Bhatia S, et al.  Iatrogenic dermatitis in times of COVID-19: a pandemic within a pandemic.  J Eur Acad Derm Venereol 2020, in press.

Desai SR, Kovarik C, Brod B, et al.  COVID-19 and PPE: treatment and prevention of skin conditions related to occupational use of personal protective equipment. JAAD, 2020 in press.

Gheisari M, Araghi F, Moravvej H, Tabary M, Dadkhahfar S.  Skin reactions to non-glove personal protective equipment: an emerging issue in the COVID-19 pandemic.  J Eur Acad Derm Venereol 2020, in press.

Maliyar K, Sachdeva M, Mufti A, Yeung J.  Reply to: Skin damage among healthcare workers managing coronavirus  disease – 2019.  JAAD 2020, in press.

MacGibeny MA, Wassef C.  Preventing adverse cutaneous reactions from amplified hygiene practices during the COVID-19 pandemic: how dermatologists can help through anticipatory guidance.  Arch Dermatol Res 2020, in press.

Patruno C, Fabbrocini G, Stingeni L, Napolitano M.  The role of occupational dermatology in the COVID-19 outbreak.  Contact Dermatitis 2020, in press.

Sim MR.  The COVID-19 pandemic: major risks to healthcare and other workers on the frontline.  Occup Environ Med 2020;77:281-282.

Consensus Reports/Reviews

Balato A, Ayala F, Bruze M, et al.  European Task Force on Contact Dermatitis statement on coronavirus disease-19 (COVID-19) outbreak and the risk of adverse cutaneous reactions. J Eur Acad Derm Venereol, 2020, in press.

Yan Y, Chen H, Chen L, et al.  Consensus of Chinese experts on protection of skin and mucous membrane barrier for health-care workers fighting against coronavirus disease 2019.  Dermatol Ther.  2020:e13310.

Case reports

Aerts O, Dendooven W, Foubert K, Stappers S, Ulicki M, Lambert J.  Surgical mask dermatitis caused by formaldehyde (releasers) during the COVID-19 pandemic.  Contact Dermatitis 2020, in press.

Campbell V, Middleton D, Donnelly J, Hunter H.  Localised mid-face miliaria as a consequence of filtering face piece (FFP) respirator use during the COVID-19 pandemic.  J Eur Acad Dermatol Venereol 2020, in press.

Navarro-Trivino FJ, Merida-Fernandez C, Rodenas-Herranz T, Ruiz-Villaverde R.  Allergic contact dermatitis caused by elastic bands from FFP2 mask. Contact Dermatitis, in press.

Xie Z, Yang Y-X, Zhang H.  Mask-induced contact dermatitis in handling COVID-19 outbreak.  Contact Dermatitis, in press.

Case series

Bothra A, Das S, Singh M, Pawar MK, Maheswari A.  Retroauricular dermatitis with vehement use of ear loop face masks during COVID-19 pandemic.  J Eur Acad Derm Venereol 2020, in press.

Singh M, Pawar M, Bothra A, et al.  Personal protective equipment induced facial dermatoses in healthcare workers managing COVID-19 cases. J Eur Acad Derm Venereol 2020, in press.


Lan J, Song Z, Miao X et al.  Skin damage among healthcare workers managing coronavirus  disease 2019.  JAAD 2020;82:1215-1216.

Lin P, Zhu S, Huang Y, et al. Adverse skin reactions among healthcare workers during the coronavirus disease 2019 outbreak: a survey in Wuhan and its surrounding regions.  Brit J Dermatol 2020, in press.

Zuo Y, Hua W, Luo Y, Li L.  Skin reactions of N95 masks and medical masks among health care personnel: a self-report questionnaire study in China.  Contact Dermatitis 2020, in press.


Dong L, Yang L, Yan L, et al.  Efficacy of hydrogel patches in preventing facial skin damage caused by mask compression in fighting against the coronavirus disease-19: a short-term, self-controlled study.  J Eur Acad Derm Venereol 2020, in press.

Hua W, Zuo Y, Wan R et al.  Short-term reactions following use of N95 respirators and medical masks.  Contact Dermatitis 2020, in press.


Abtahi-Naeini B.  Frequent handwashing amidst the COVID-19 outbreak: prevention of hand irritant contact dermatitis and other considerations.  Health Sci Rep 2020;3:e163.

Beiu C, Mihai M, Popa L, Cima L, Popescu MN.  Frequent hand washing for COVID-19 prevention can case hand dermatitis: management tips.  Cureus 2020;12:e7506.

Erdem Y, Altunay IKK, Aksu Cerman A, et al.  The risk of hand eczema in healthcare workers during the COVID-19 pandemic: do we need specific attention to prevention strategies?  Contact Dermatitis 2020, in press.

Giacalone S, Bortiluzzi P, Nazzaro G. The fear of COVID-19 infection is the main cause of the new diagnoses of hand eczema: report from the frontline in Milan.  Dermatol Ther 2020; in press.

Guertler A, Moellhoff N, Schenck TL, et al.  Onset of occupational hand eczema among healthcare workers during the SARS-CoV-2 pandemic – comparing a single surgical site with a COVID-19 intensive care unit.  Contact Dermatitis 2020, in press.

Plum F, Yuksel  T, Agner T Norreslet LB.  Skin barrier function after repeated application of alcohol-based hand rub following intervention with water immersion or occlusion.  Contact Dermatitis, 2020, in press.

Facial Protection – general public

Szepietowski JC, Matusiak L, Szepietpowska M, Krajweski PK, Bialynicki-Birula R.  Face mask-induced itch: a self-questionnaire study of 2,315 responders during the COVID-19 pandemic.  Act Derm Venereol 2020, in press.