DEPARTMENT OF CLINICAL EPIDEMIOLOGY

University of the Philippines, College of Medicine

RESEARCH CAPSULE IDC 211

Research Title:
Association between face-mask induced itch and type of face masks (three layers surgical, cloth and respirator mask)
used by UP Manila students during the COVID-19 pandemic.

Research Question (PECO format): Study design:

What is the prevalence of face-mask induced itch Analytical Observational – Cross-sectional study
among UP Manila students who wear face masks
(three layers surgical, cloth and respirator mask)
during the COVID-19 pandemic?
Researcher: Contact information:
Email address:
Mobile numbe r:

Introduction / Significance of the proposal:

Face masks are believed to provide protection from human-to-human respiratory viral transmission and has been
suggested that they effectively control influenza (Javid et al, 2020). Face masks are also used by the general public
in times of pandemic such as SARS in 2003 and now during the coronavirus disease 2019 (COVID-19) (Wang et
al, 2020). Under the Bayanihan to Heal as One Act or RA 11469, mandatory use of face masks in public areas have
been passed in the Philippines to ensure personal and public safety at all times among Filipinos (Official Gazette
PH). This resulted to the use of face masks of the general public and for longer periods of time. While there are
numerous studies on the use of personal protective equipment, there is little research into itch related to the use of
face masks. Itch, a cutaneous sensation leading to scratching, is an important common symptom is both
dermatological and systemic disorders (Foo et al, 2006). It is fairly common among people with dry skin (Reszke et
al, 2019). Itch can induce scratching which would lead to touching the surface of the mask or taking it off which
can then result to the inappropriate use of face masks. Such actions may reduce the protection it offers and may even
promote the spread of viral infection (Szepietowski et al, 2020). This study aims to evaluate the prevalence of face-
mask induced itch among UP Manila students who wear face masks during the COVID-19 pandemic.

Summary of Literature

Face masks are frequently used incorrectly and this can increase the chance of transmission because of moisture
retention, poor filtration and reuse (WHO, 2009). Itch is a sensation which may lead to scratching. Putting a hand
underneath the masks to scratch once face will bring in contaminants and potentially spread these pathogens as well
(Stone et al, 2020). In a study conducted among Polish students by Szepietowski et al in 2020, they were able to
identify the prevalence of face mask use and face mask-induced itch. Majority of the respondents reported moderate
intensity of the itch using the Itch Numerical Rating Scale and responders who wore masks for longer periods more
frequently reported itch. Szepietowski’s study also reported the presence of skin conditions among the respondents
namely acne, atopic dermatitis and seborrheic dermatitis and their correlation with face-mask induced itch.
However, the study was only limited to the most common skin diseases of the Polish students. Types of face masks
used in the study were only limited to those used and produced in Poland.

General Objective: This study aims to evaluate the prevalence of face-mask induced itch among UP Manila
students who wear face masks during the COVID-19 pandemic.

Specific Objectives:
1. To determine the types of face masks used (three layers surgical, fabric/cloth and respirator mask) by UP
Manila students during the COVID-19 pandemic
2. To determine the mean daily duration of face mask use (up to 1 hour, 2 hours, 3 hours and more than 5
hours) among the respondents
3. To evaluate the intensity of face-mask induced itch using the Itch Numeric Rating Scale (0 for no itch, 1
to <3 for mild itch, 3-7 for moderate itch and ≥7 to 9 for severe itch and ≥ very severe itch)
4. To evaluate the modalities applied to relieve itch (Scratched face Without Removing the Mask (SWRM),
Scratched face after Removing the Mask (SRM), took the Mask Off and did not put it on again (MO),
Scratched face with Foreign Objects (SFO))
5. To identify the correlation between the presences of face-mask induced itch and the type of mask used.
6. To identify the correlation between the intensity of the itch felt and the type of mask used.
7. To identify the correlation between the length of mask use and the intensity of the itch felt.

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 DEPARTMENT OF CLINICAL EPIDEMIOLOGY
University of the Philippines, College of Medicine

Summary of Methodology (Describe the population, exposures and outcomes. Diagrams preferred)

Due to the current pandemic, social distancing must be practiced so the study will be conducted via an online survey
among enrolled students of the University of the Philippines Manila. A Google Form Survey will be given to the
respondents which contains the questionnaires and consent form for the study. Snowball sampling will be done to
reach the appropriate population needed for the study. Paired Sample T-Test will be used to determine the difference
between the means of the exposures and Spearman Correlation will be used to assess the correlation of the variables
in the study.

Population: UP Manila students of AY 2020-2021

Exposure: Different types of face masks (fabric/cloth mask, surgical mask, respirator mask, N95 mask) and duration
of mask use in a day (up to 1 hour, 2 hours, 3 hours and more than 5 hours)
Outcome: Prevalence of face-mask induced itch
Control Group: N95 masks

Demographic data Self-assessment of skin

survey on face mask-
induced Itch content:

Statistical Analyses
Online Survey using

(presence/history of acne, dermatitis,

Self-questionnaire
Paired Sample T-Test
rosacea)
Type of Face Masks used
Google Forms

(Cloth, surgical, N95, respirator

Intensity of itch (using Itch Numeric Spearman Correlation
mask)
Rating Scale)
content:

Duration of mask use in a day Modalities to relieve itch (SWRM,

(up to 1 hour, 2 hours, 3 hours WRM, MO, SFO)
or more than 5 hours)

Biases identified and strategies to address these:

Recall biases among participants will be present since the survey will rely on self-reporting. Blinding will be done
to the respondents and in creating high quality questionnaires so that it will not be biased on the expected outcomes.
Questionnaires will be made to ensure that respondents are given sufficient time to answer and to yield results which
are accurate and reliable that can answer the objectives of the study.

Ethical Considerations:
The study will be conducted only upon the approval of the University of the Philippines Manila Research Ethics
Board (UPMREB).

Bibliography:

Foo CC, Goon AT, Leow YH, Goh CL. Adverse skin reactions to personal protective equipment against severe
acute respiratory syndrome – a descriptive study in Singapore. Contact Dermatitis 2006; 55: 291-294

Javid B, Weekes MP, Matheson NJ. Covid-19: should the public wear face masks? BMJ 2020; 368: m1442

Official Gazette of the Philippines. 2020. Implementing Rules and Regulations of Section 4(aa) of Republic Act No.
11469 or “Bayanihan to Heal As One Act”. Available at:
https://www.officialgazette.gov.ph/downloads/2020/03mar/20200401-IRR-RA-11469-RRD.pdf

Reszke R, Szepietowski JC. Itch and psyche: bilateral associations. Acta Derm Venereol 2019; 99: 1016-1021

Stone T, Kunaviktikul W, Omura M, Petrini M. 2020. Editorial: Facemasks and the Covid 19 pandemic: What
advice should health professionals be giving the general public about the wearing of facemasks? Available at: doi:
10.1111/nhs.12724

Szepietowski J, Matusiak L, Szepietowska M, Krajewski P, Bialynicki-Birula R. 2020. Mask-Induced Itch: A Self-

questionnaire Study of 2,315 Responders During the COVID-19 Pandemic. Acta Dermato-Venerelogica 2020; 100:
adv00152

Wang MW, Zhou MY, Ji GH, Ye L, Cheng YR, Feng ZH et al. Mask crisis during COVID-19 outbreak. Eur Rev
Med Pharmacol Sci 2020; 24: 3397-3399

World Health Organization. (2009). Advice on the use of masks in the community setting in Influenza A (H1N1)
outbreaks.

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