Increase in Perioral Dermatitis May Be Linked to Mask Use During COVID-19 Pandemic

Factors associated with face mask use during the COVID-19 pandemic may account for exacerbation of perioral dermatitis.

The increase in the incidence of perioral dermatitis from pre-COVID-19 periods to mid-COVID-19 may be associated with the use of face masks, according to study findings presented at the 2023 Annual Meeting of the American Academy of Dermatology (AAD), held from March 17 to 21, 2023, in New Orleans, Louisiana.

Various facial skin reactions have been associated with the recent increased use of face masks during the COVID-19 pandemic. Investigators therefore evaluated the association between mask use and the incidence of perioral dermatitis, a benign inflammatory eruption due to genetic and environmental factors, among patients during this time period.

Researchers conducted a retrospective, single-center chart review for adults and adolescents at least 12 years of age with rosacea, acne, and/or perioral dermatitis undergoing treatment at NYU Langone Health in New York City. The researchers identified 7184 encounters (68.78% women) that occurred in 2019 (pre-COVID-19) and 7993 (74.79% women) that occurred in 2020 (mid-COVID). The age ranges of patients treated in both years were similar.

Investigators identified 262 patients who were diagnosed with POD perioral dermatitis by a dermatologist from April 2019 through December 2019, and 375 who were diagnosed with perioral dermatitis from April 2020 through December 2020 (3.65% to 4.69% respectively; P =.0014). The percentage of chart-reported mentions of mask use also increased from 0.43% to 10.53% (P <.0001) from 2019 to 2020. Chart-reported mask use was highest among patients aged 35 to 44, 55 to 64, and 65 to 74 years.

Microbiome dysbiosis and changes in skin temperature, erythema, hydration, and sebum secretion associated with FMs could account for the exacerbation of POD.

Investigators used multivariable logistic regressions to analyze the likelihood of perioral dermatitis before and after the start of the pandemic. Sex, age, mask use, month, and year were independent variables.

Mask use by month increased steadily from 3.1% in April 2020 to 12.2% in December 2020. Mask use was associated with 2.54-times increase in the odds of developing perioral dermatitis (95% CI, 1.98-3.25) according to multivariable logistic regression. When controlling for the years 2019 and 2020, the investigators found no statistically significant difference in the likelihood of developing perioral dermatitis (P =.24).

Study limitations include its retrospective, single-center design, as well as chart-reported mask use as a proxy for actual mask use.

“Reports of [face mask] use increased dramatically mid-COVID and appeared to correlate with an increased likelihood of [perioral dermatitis]. Microbiome dysbiosis and changes in skin temperature, erythema, hydration, and sebum secretion associated with [face masks] could account for the exacerbation of [perioral dermatitis],” the investigators concluded. However, “Despite controlling for multiple covariates, the findings may result from an unidentified confounder.”

This article originally appeared on Dermatology Advisor


Nahm WJ, Nagler AR, Milam EC. Association of perioral dermatitis and mask usage during the COVID-19 pandemic. Poster presentation at: AAD 2023 Annual Meeting; March 17-21, 2023; New Orleans, LA. Poster 42346.