The prevalence, characteristics and prevention status of skin injury caused by personal protective equipment among medical staff in fighting COVID-19: A multi-center, cross-sectional study

By featured2, News

Qixia Jiang, Siping Song, Jihong Zhou, Yuxiu Liu, Aihua Chen, Yuxuan Bai, Jing Wang, Zhixia Jiang, Yanhong Zhang, Haiying Liu, Jiao Hua, Jinli Guo, Qiuying Han, Yongli Tang, and Jiayu Xue

Advances in Wound Care © Mary Ann Liebert, Inc. DOI: 10.1089/wound.2020.1212

According with this study, 80% of medical staff in Wuhan reported that different skin injuries damaged their health and increased the risk of infection.

The heavy and airtight PPE made it difficult to volatilize perspiration, which changed the skin microclimate and decreases skin tolerance. Sweating stimulated the skin and caused redness, pain, itching or prickling, which might be the main cause of moisture-associated skin damage.

Soaked skin combined with pressure increased friction coefficient between the PPE and skin, when masks and goggles were removed quickly, skin tears was ready to happen. Wearing grade 3 PPE was higher than in ones wearing grade 2 PPE (88.5% vs 21.0%)


Objective: To investigate the prevalence, characteristics, and preventive status of skin injuries caused by personal protective equipment (PPE) in medical staff.

Approach: A cross-sectional survey was conducted online for understanding skin injuries among medical staff fighting COVID-19 in February 8–22, 2020. Participants voluntarily answered and submitted the questionnaire with cell phone. The questionnaire items included demographic data, grade of PPE and daily wearing time, skin injury types, anatomical sites, and preventive measures. Univariable analyses and logistic regression analyses were used to explore the risk factors associated with skin injuries.

Results: A total of 4,308 respondents were collected from 161 hospitals and 4,306 respondents were valid. The overall prevalence of skin injuries was 42.8% (95% confidence interval [CI] 41.30–44.30) with three types of device-related pressure injuries, moist-associated skin damage, and skin tear. Co-skin injuries and multiple location injuries were 27.4% and 76.8%, respectively. The logistic regression analysis indicated that sweating (95% CI for odds ratio [OR] 87.52–163.11), daily wearing time (95% CI for OR 1.61–3.21), male (95% CI for OR 1.11–2.13), and grade 3 PPE (95% CI for OR 1.08–2.01) were associated with skin injuries. Only 17.7% of respondents took prevention and 45.0% of skin injuries were treated.

Innovation: This is the first cross-sectional survey to understand skin injuries in medical staff caused by PPE, which is expected to be a benchmark.

Conclusion: The skin injuries among medical staff are serious, with insufficient prevention and treatment. A comprehensive program should be taken in the future.

Advances in Wound Care © Mary Ann Liebert, Inc. DOI: 10.1089/wound.2020.1212

Skin Reactions to Non-glove Personal Protective Equipment: An Emerging Issue in the COVID-19 Pandemic

By featured, News

Mehdi Gheisari; Farnaz Araghi; Hamideh Moravvej; Mohammadreza Tabary; Sahar Dadkhahfar.

J Eur Acad Dermatol Venereol. 2020 Apr 17. doi: 10.1111/jdv.16492

According with this study, N95 respirator masks are made of polypropylene fabric processed by a non-woven technology and should fit tightly to the face to be effective.

The study by Foo and colleagues revealed that 35.5% of the staff who used N95 masks regularly experienced acne, facial dermatitis and pigmentation of nasal bridge, cheeks and chin. In this study, acne was one of the most prevalent skin reactions related to the use of N95 respirator masks.

The dermatitis that often presented with pruritic skin lesions was mostly irritant type but allergic contact dermatitis due to ADHESIVES or other parts of the respirator masks such as RUBBER STRAPS and METAL CLIPS was also reported.

Several factors including humidity, warm environment and occlusion due to local pressures could explain the exacerbation of these conditions.


Protecting healthcare workers (HCWs) is crucial during Corona Virus Disease 2019 pandemic and requires wearing personal protective equipment (PPE) [1]. While most of the studies have focused on the skin reactions caused by gloves, other PPE such as gowns, respirator masks, face shields and goggles are also worn by HCWs for long hours during the current epidemic and skin irritations caused by these equipment may cause discouragement of health workers from using them [2]. In this letter we have focused on the reaction caused by non-glove PPE.

J Eur Acad Dermatol Venereol. 2020 Apr 17. doi: 10.1111/jdv.16492