Researchers in Wuhan, China have found hydrogel patches can be effective in preventing both nasal bridge and cheek skin injury in healthcare workers wearing the N95 respirator mask.
In a letter published online ahead of print in the journal Dermatological Therapy (Aug. 12, 2020), the authors wrote that people with thin facial fat layers, high cheekbones and high nose bridges are more likely to undergo severe facial skin damage due to higher shear forces, pressure and friction from wearing the N95 mask.
“Developing a novel N95 respirator with hydrogel patches fixed on the inner face may greatly reduce this damage and facilitate the application for healthcare workers,” the authors suggested. During the Covid-19 pandemic, masks are essential for the safety of healthcare workers. However, mask-related skin damage to cheeks and nasal bridges has a reported incidence of over 70% among frontline healthcare workers during the pandemic, according to a study published in the Journal of the American Academy of Dermatology (May 2020; 82(5):1215-1216). Preliminary research conducted in Wuhan revealed that a hydrogel patch can alleviate the skin damage from long hours of mask-wearing.
The authors of the letter conducted a randomized, controlled study to explore whether hydrogel patches adequately protect the nasal bridge and cheeks from skin injury by an N95 mask during at least seven days of continuous use over a 14-day period.
Twenty-six frontline healthcare workers were randomized into hydrogel and control groups--those operating with or without a W-shaped hydrogel patch over their cheeks and nasal bridge while wearing an N95 mask for at least seven full working days over two weeks.
Mask sealing was ensured by proper adjustment and checking for leaks during deep breathing. Questionnaires were completed by the participating healthcare workers who provided subjective appraisals of their skin damage prior to the start of the study and after 14 days. Their responses were recorded on a numeric scale, with five indicating the most severe. Researchers found hydrogel use led to significant score reductions in pain, itching and indentation. Further, burning on the nasal bridge, although not on the cheeks, also scored lower.
The indentation scores on both cheeks (1.33; 95% CI, 0.18 to 2.47; p=0.03) and nasal bridge (1.45; 95% CI, 0.36 to 2.54; p=0.01) showed the most marked decrease on day 14 in the hydrogel subjects. Other skin injuries such as dryness, redness, and swelling also got lower scores in the hydrogel group, but these were not significant reductions (p>0.05).
“A hydrogel patch showed clear benefits in lowering the indentation, pain, and itching caused by N95 mask compression, as reflected by the lower total questionnaire scores in the hydrogel group,” the authors wrote. “This suggested a sustained protective effect of these patches against skin damage caused by an N95 mask.”
No differences appeared in the total scores of the control group on day 14 compared to day 0. The induced facial skin damage appeared therefore not to be cumulative and the skin could likely repair itself to some extent after mask removal. The authors note their analysis was limited by the relatively short hydrogel intervention period and that it did not assess the effects of mask compression on the nasal bridge in any detail, which may be the most affected part of the skin.