Complications of masks, side effects of masks and ways to prevent them.

Wearing a protective face mask especially during these COVID times has numerous well documented health benefits. They prevent the spread of not only COVID 19 but many many other respiratory viruses and bacteria as well. Masks are advisable even after vaccination. Masks however have some down sides as well. There are well documented complications of masks and side effects of masks that need to be completely and carefully understood.

Common complications of masks.

1. Headaches.

 Head aches are  one of the common complications of masks. A tight fitting mask could irritate the superficial sensory nerve branches of the Trigeminal and Occipital nerves causing a head ache. Tight bands and ties could impede the venous drainage of the scalp resulting in a sense of heaviness.  A  very tight mask may also induce a mild hypercarbia (increase in the blood levels of CO2) due to rebreathing. Hypercarbia could trigger a headache. Hypercarbia induced head aches  are one of the frequent side effects of face masks. Worsening headaches is one of the well known complications of masks. It is one of the most easily preventable side effects of masks as well.

2. Dry mouth.

Wearing a mask for a long period of time can lead to “dryness” in the mouth because a mask induces breathing through not only the nose but the mouth as well. Breathing through the mouth causes a decrease in the secretion of saliva. While wearing a mask, people also tend to drink less water because it is cumbersome to remove a mask to hydrate yourself.. This worsens the dryness even further. Reduction in saliva (with its natural antiseptic properties) with dryness also results in a favourable environment for bacterial growth. A dry mouth is one of the more common side effects of masks.

3. Mask mouth.

The combination of a dry mouth and bacterial overgrowth can cause halitosis (foul smelling breath). Halitosis is also known as a “mask mouth”. Halitosis induced social isolation is one of the distressing complications of masks. Halitosis can be reduced or prevented by consciously breathing through the nose instead of the mouth, drinking a lot of water, avoiding or minimizing caffeine, cigarettes, and using alcohol free mouth washes. It is also important to consult a dentist and ensure that you have no periodontal (gum) disease, or cavities in your teeth, both of which can worsen halitosis. Worsening halitosis is one of the well known complications of masks. It is one of the most easily preventable side effects of masks as well.

4. Maskene (mask induced acne / acne mechanica).

Maskne (mask induced acne) is one of the other  common complications of masks particularly when they are worn for long periods of time. Maskne may manifest as frank pimples, folliculitis, redness or irritation in the area of the face that the mask covers. Wearing a mask for long periods of time results in an environment of increased humidity and warmth under the mask as a result of warm exhaled air. A warm humid environment is favourable for bacterial growth.

A masked face is also, understandably, not washed as frequently as a non masked face. Infrequent washing results in clogging of the pores of the skin, accumulation of dead skin cells on the surface and an accumulation of oil (sebum) on the surface. These phenomena further facilitate bacterial overgrowth. If a mask fits too tightly it could result in friction on the skin surface on the edges of the mask as well.

5. Contact dermatitis.

Contact dermatitis is one of the common complications of masks. Some masks are chemically treated or have a surface coating of chemicals. These chemical and coatings could induce a skin allergy in some sensitive people. Mask induced contact dermatitis is one of the increasingly observed side effects of masks in dermatological practice.

6. Folliculitis.

The warm wet envinonemnt under a mask and the resulting bacterial overgrowth can result in infections of hair follicles of the skin and cause painful folliculitis. Worsening folliculitis is one of the well known complications of masks. It is one of the most easily preventable side effects of masks as well.

7. Rosacea.

Rosacea is a red painful rash on the skin which can be one of the more uncommon side effects of masks. It is often associated with and untreated H. Pylori infection in the stomach. It is also known to be associated with a mite that lives on the human skin the Demodex Follicularum. It is also known to be associated with the overgrowth of Bacillus Oleronius on the skin. A familial dysregulation of cathelicidin metabolism is also known to worsen Rosacea. Worsening Rosasea is one of the well known complications of masks. It is one of the most easily preventable side effects of masks as well.

Prevention of complication of masks & minimizing side effects of masks:

Side effects of masks and complications of masks could be prevented by the following:

• Wash your face frequently with warm water at least once in the morning and once at night and preferably once in your work place during your work shift. Pat the skin dry. Do not wipe it. Wiping can cause micro abarasions.
• Use a very gentle skin cleanser. Specifically, stay away from alcohol, retinoids, or perfume containing cleansers. Moisturizers containing ceramides or dimethicone are preferable.
• Use a non-comedogenic (does not block the pores of the skin) moisturizer on the skin.
• Never use heavy makeup while wearing a mask.
• Wash and dry a re-usable fabric mask before using it again.
• Never ever wear a wet face mask. A wet mask does not protect against COVID 19 and it also promotes bacterial growth under it.
• Do not reuse masks that are designated as disposable.
• Try and remove your mask for about 15 minutes after every 4 hours of wearing it. Wash your hands and make absolutely sure you are socially distanced before taking a mask break. This is a specific recommendation by the American Academy of Dermatology.
• Choose the right mask depending on your exposure risk, duration of potential exposure, your age, co-morbidities etc
• Cotton masks are preferable to masks made from synthetic fabrics such as rayon, polyester and nylon. Avoid masks made of synthetic fabrics. These materials can irritate the skin.
• Dab a bit of anti bacterial anti fungal face powder onto your nose and around your mouth before putting a mask on.