The scientific community generally agrees that masks are essential to prevent the transmission of coronavirus, and so do politicians and most people. However, it is also the case that prolonged or incorrect use, combined with previous skin conditions, can cause problems. Dr Leandro Martínez, the director of the Dermatology Clinical Management Unit at the Regional Hospital, discusses these matters in this interview.
What did you think of the decision to make masks obligatory in Andalucía?
It is the main tool to reduce contagion. When two people are wearing masks the possibility of one infecting another is minimal. Keeping a distance and using a mask are the only ways to prevent transmission, and if distance can't be maintained then using masks is the only other option, at least while there is still a high probability of contagion, and at the moment there is.
Do you think they should have taken this decision earlier?
I think there was a certain logic to them doing it when they did. When outbreaks start occurring you have to step up protective measures.
Masks protect, but they can also damage the skin. What are the main problems with them?
We are seeing two things. One is the consequence of irritation, when it harms or damages the skin. We're seeing that in people who wear a mask for long periods of time and in areas where there is most friction, such as the bridge of the nose, the ears and sometimes on the cheeks. It is damage caused by rubbing, just like a shoe can rub your foot. It happens because the mask is not properly adjusted, or is worn for a long time. In that case, you should use a different type of mask or adjust the parts that go over the ears so they are longer, or put a dressing on to protect the nose. Secondly, we are seeing that some dermatological problems are getting worse through wearing a mask, bearing in mind three variables which are the type of skin, especially sensitive skin, the type of mask, which should be officially approved and made with natural fabrics, and the time they are worn. If I wear a mask for 14 hours and I have these conditions, they are going to get worse.
And what are the conditions that get worse?
For example acne, especially in the area covered by the mask because it creates a hot and damp ambience; processes similar to acne such as rosacea, which is characterised by the apparition of pustules and red blotches; or very common processes such as seborrheic dermatitis, which affects the areas at the side of the nose. Also periorial dermatitis, around the mouth.
Why do they get worse?
Undoubtedy because of the occlusion caused by the mask, that dampness. That gets even worse when the mask itself gets damp and we have to keep wearing it. And also bear in mind that we are in a process where everybody has been subjected to stress to a greater or lesser extent, and all these dermatological problems get worse with stress.
Have you noticed an increase in consultations?
Yes, there has been, and that is strange because sometimes the patients are a bit disorientated and when you show them what the problem is they say they should have realised it would be the mask.
And what solution is there, because we have to wear masks?
You have to choose a breathable mask made in the most natural fabric possible, but you also have to know how to use it properly. The same thing occurs with sun creams, they are no use if they are not used properly. Masks have to be washed regularly if that is possible, not just left anywhere, and you have to care for your skin. When you get home, before going to bed, you need to be a bit more meticulous than normal about cleaning your skin. It has to be clean and hydrated if the mask isn't going to damage it. And of course if you have dermatitis or another problem, you have to treat it to get rid of it.
Do masks affect the part of the face they cover?
Of course, in fact one general piece of advice is that you shouldn't use make-up on that part of the face, or at least choose oil-free make up so it doesn't create an occlusive effect, because you have to remember that if you put make-up on, cream and then the mask, that creates occlusion. People with sensitive or reactive skin, or with an existing problem, have to be careful.
What about lipstick?
I haven't actually seen many problems caused by lipstick, because nowadays most tend to hydrate and that's a good thing.
In skin conditions such as labial herpes, do the masks protect or affect them?
In this case the mask can actually be a good thing because one of the things that triggers labial herpes in the summer is the sun, and the mask protects against that.
Masks made out of different materials and patterns are becoming popular. Do people need to be careful with those?
You should always used officially approved masks, although it all depends on what you are looking for. If you want a 'hygienic' fabric mask, which most of these designer ones are, and you want to look after your skin because you are going to be wearing a mask for a long time, it should be made with the most natural materials possible. It is best to avoid synthetic fabrics and keep an eye on how the skin reacts when it comes into contact with the mask.
What about children? Their skin is normally more delicate.
I think about 'atopic' children the most. In their case it is best to use masks made from natural fabrics and hydrate the area well with a light cream, although that is good advice for all of us. It's not a bad idea to put a little cream on before the mask, but always letting it be absorbed first.
Do hand sanitisers also cause problems?
Yes, there are people who are washing their hands excessively or using too much hydroalcoholic gel, and that can cause damage to the lipid mantel which protects the skin. You need to use gels which don't have a high alcohol content and use cream after washing your hands. Oh, and dry them very well too, because the damp can cause irritative dermatitis. In fact, we are seeing more problems and lesions to the hands from hydroalcoholic gels and compulsive hand-washing than those associated with the mask and damage to the face.