DOI: 10.1111/jdv.

16925 JEADV

REVIEW ARTICLE

‘Occupational dermatoses from Personal Protective

Equipment during the COVID-19 pandemic in the
tropics – A Review’
H.C. Lee,1,* , C.L. Goh2
1
Dermatology Department, KK Women’s and Children’s Hospital, Singapore
2
National Skin Centre, Singapore
*Correspondence: H.C. Lee. E-mail: dermhclee@gmail.com

Abstract
The COVID-19 pandemic has enveloped the world and there has been a high incidence of occupational dermatoses
related to Personal Protective Equipment (PPE) amongst healthcare workers (HCWs) during this period. Prevention and
management of these conditions will not only improve staff morale and quality of life, but will also minimize the risk of
breaching PPE protocol due to such symptoms. The tropical climate in Singapore predisposes HCWs to more skin dam-
age and pruritus due to intense heat, high humidity and sun exposure. The effects of friction, occlusion, hyperhidrosis
and overheating on the skin in the tropics should not be neglected. Preventive measures can be taken based on our rec-
ommendations, and the working environment can be made more conducive for frontline HCWs. We review the literature
and discuss various preventive and management strategies for these occupational skin diseases for our frontline HCWs,
especially those working in less controlled working environments beyond the hospital in Singapore. Shorter shifts and
frequent breaks from PPE are recommended. Duration of continuous PPE-usage should not exceed 6 h, with breaks in
non-contaminated areas every 2–3 h to hydrate and mitigate the risk of skin reactions. Other strategies, such as teleder-
matology, should be considered so that consultations can remain accessible, while ensuring the safety and well-being of
our clinical staff.
Received: 14 June 2020; Accepted: 21 August 2020

Conflict of Interest
None reported.

Funding Sources
None reported.

COVID-19 pandemic in Singapore
The first cluster of COVID-19 cases was reported in Wuhan,
China in Dec 2019. It was not long before the disease spread
exponentially across the globe, and the World Health Organiza-
tion (WHO) eventually declared COVID-19 as a pandemic on
12 March 2020. Since then, this pandemic has resulted in more
than 19 million cases, with more than 12 million recoveries and
over 700 000 deaths globally.
Singapore confirmed its first imported case of COVID-19
from China on 23 Jan 2020. Local transmission became apparent
in February 2020, and by March, multiple COVID-19 clusters
were identified in dormitories for foreign workers. To facilitate
extensive ‘proactive’ screening and create more bed capacity for
isolation and care of COVID-19 patients, Singapore has since
ramped up operations in hospitals, worker dormitories, outdoor
screening centres and community care and recovery facilities.
Healthcare workers (HCWs) have been deployed across the
island to these facilities. Given the current evidence of how it is
spread, these frontline HCWs require personal protection equip-
ment (PPE) with respiratory droplet and contact precautions to
mitigate the risk of viral transmission.
There is a high incidence of occupational skin disease from
PPE amongst HCWs.1,2 During the Severe Acute Respiratory
Syndrome (SARS) epidemic, PPE use was associated with high
rates of adverse skin reactions in HCWs in Singapore.3
To date, even higher incidences of PPE-related dermatoses
have been reported in the current COVID-19 pandemic.4–6 If
untreated, these occupational dermatoses and their symptoms
can affect PPE compliance and staff morale. They can also result
in inadvertent PPE breaches or PPE failure due to symptoms or
discomfort, putting HCWs at risk of COVID-19 transmission at
work.7 Prevention, early recognition and prompt management

JEADV 2021, 35, 589–596 © 2020 European Academy of Dermatology and Venereology
590
of these dermatoses are therefore critical to protect HCWs in
this pandemic.
Unfortunately, it is difficult for HCWs to get dermatology
consults given the current circumstances in COVID-19. Many
have anecdotally chosen to self-medicate or ignore their symp-
toms until they worsen.
Singapore lies near the equator and is well known for its
perennial high temperatures and humidity as is in most coun-
tries in the tropics. HCWs have been deployed, beyond hospitals,
to facilities with less controlled environments. The heat, humid-
ity and prolonged duration wearing PPE in these environments
can make HCWs vulnerable to various skin disorders and heat
stress. We review the literature and discuss strategies to prevent
and manage adverse skin reactions due to PPE in HCWs in trop-
ical climates like Singapore.
Skin reactions related to N95 Masks and Goggles
During SARS in Singapore, 35.5% of staff using N95 masks reg-
ularly for an average duration of 8 h/day (mean period:
8.4 months) self-reported adverse skin reactions, including acne
(59.6%), facial itch (51.4%) and rashes (35.8%).3
During the current COVID-19 pandemic, 97% of frontline
HCWs in China reported PPE-related skin reactions.4 Those
who wore medical devices (N95 mask and goggles) longer than
6 h had higher risks of skin damage in corresponding sites than
those who did for a shorter duration. Wearing a face shield for a
longer duration (>6 h) was not a significant risk factor in caus-
ing forehead skin damage.
Prolonged usage of these facial protection devices is therefore
a major predisposing factor for skin damage. On an administra-
tive level, it would be advisable to introduce more breaks where
feasible and shorten shifts to reduce the duration of continuous
PPE-usage to no more than 6 h, especially in the warm and
humid climate in the tropics.
1) Acne
For those with pre-existing acne vulgaris, repetitive pressure and
friction from N95 masks and goggles can cause pilosebaceous
ductal occlusion and aggravate pre-existing inflammatory
papules.4 HCWs with no prior history of acne can develop acne
mechanica, as mechanical trauma from the mask and goggles
can cause rupture of micro-comedones, resulting in inflamma-
tion. (Fig. 1) The mask and goggles also create a hot and humid
‘micro-climate’, resulting in excess sweat and sebum accumula-
tion on the face.8 This promotes bacterial growth (Propionibac-
terium acnes) and creates an ideal environment for acne. The
tropical climate in Singapore has high humidity, high tempera-
ture and sun exposure, all of which have been reported to exac-
erbate acne.9
We recommend that HCWs take regular breaks to minimize
the friction and pressure from these devices. Facial cleansers
containing salicylic acid (SA) and benzoyl peroxide (BP) can be
JEADV 2021, 35, 589–596
Lee and Goh
Figure 1 a & b. A HCW developing acne over bilateral cheeks
after wearing N95 masks daily for 1 month.
used before and after wearing masks. Topical antibiotics, BP
2.5% cream or gel or combination creams, can be used for acnei-
form papules. Topical retinoids (e.g. adapalene cream or gel)
can be used at night to treat comedones. These topicals should
be used judiciously to avoid any risk of skin irritation. Lower
concentration of retinoids may be preferable to minimize skin
irritation. In addition, non-comedogenic, oil-free moisturizers
are recommended when indicated. Dermatology consultation is
warranted in severe or recalcitrant cases where systemic antibi-
otics may be needed.
2) Skin indentations and Pressure injuries (PIs)
Healthcare workers wearing goggles and N95 masks have
reported skin indentations and mild erythema, even after 1–2 h.
Many HCWs have anecdotally neglected these early warning
signs of PIs. It is important to highlight that, with constant pres-
sure to the same sites daily, indentations and erythema will pro-
gress to eventual PIs with blisters, erosions and ulcers. The nasal
bridge and cheeks are common sites of pressure.4 (Fig. 2a,b) The
tropical climate may exacerbate the hyperhydration effects of
excess moisture accumulated under N95 masks causing skin
maceration. This increases the risk of skin damage and PIs in
corresponding sites and can lead to secondary infections due to
micro-abrasions.
To prevent PIs, the first goal is to prepare the skin prior to
donning PPE.10 We recommend gentle pH-balanced face cleans-
ers, and avoiding the use of alkaline soaps or cleansers that dam-
age the skin barrier. After patting the face dry, a liquid skin
sealant (e.g. silicone gels, 3MTMCavilonTM No Sting Barrier
Film) can be applied over potential sites of pressure. Avoid
applying these skin protectants near the eyes and mucous mem-
branes. Rub them gently into the skin and ensure the skin is fully
dry before donning PPE.
© 2020 European Academy of Dermatology and Venereology
Occupational Dermatoses from PPE during COVID-19 (Review)
Figure 2 (a) A painful pressure erosion over the nasal bridge due
to N95 masks after 2 weeks. (b) Skin indentations on the cheeks
due to N95 masks, and an attempt to apply prophylactic hydrocol-
loid dressings on the nasal bridge to prevent pressure injuries.
Mask refitting was advised.
Petrolatum-based products or oils are not recommended in
view of the possibility of promoting mask slippage and compro-
mising the integrity and fit of the mask.10,11 Thick dressings are
also discouraged as these will increase the intensity of pressure
on the skin and compromise the mask fit.10
To minimize the pressure intensity, thin prophylactic dress-
ings have been suggested.6,12,13 This is controversial as there is
currently no evidence to ensure that dressings will not compro-
mise the wearer’s safety from COVID-19.10 If thin dressings
instead of the above recommendations have to be used, we
strongly recommend doing seal checks and mask refitting as pre-
cautionary measures. While this may be limited by time and
supply constraints, the safety of frontline HCWs is paramount.
Two HCWs were infected with Ebola virus due to incorrect PPE
use or PPE failure.14 It will be useful to obtain more definitive
data regarding successful mask refitting of N95 masks with thin
prophylactic hydrocolloid dressing.
The second goal is to relieve pressure by minimizing the dura-
tion of pressure.10 HCWs should take frequent breaks of about
10–15 min (in non-contaminated areas) to remove the devices
from the face every 2 to 3 h. It is also important to wash hands
before and after touching the mask.
Lipid or ceramide-based moisturizers should be applied at
least 1 h before donning PPE. When no longer on duty, it is
important to moisturize the face regularly to maintain skin bar-
rier integrity.
If significant PIs are present, HCWs should seek medical
advice. Wound dressings can be prescribed depending on the
nature of the wound. Ideally, skin injuries should be allowed to
heal before resuming the PPE mask. Topical antibiotics can be
applied to micro-abrasions with secondary infections.
JEADV 2021, 35, 589–596
591
If significant PIs develop from goggles, face shields or visors
can be considered.
3) Contact and Delayed Pressure Urticaria
Well-fitted N95 masks and goggles create a tight seal on facial
skin. These devices, along with their accompanying straps, can
cause contact or delayed pressure urticaria.6,15 We encourage
HCWs to take regular breaks every 2 to 3 h to minimize the
pressure and friction from these PPE. We recommend prophy-
lactic non-sedating oral antihistamines 1–2 h prior to the shift
duty.
4) Cheilitis
Lip licker’s dermatitis or cheilitis has been reported in frontline
HCWs.16 This has been attributed to frequent licking of lips due
to dehydration and reduced fluid intake, which can be exacer-
bated in hot and humid climates. We recommend regular appli-
cation of lipid-bearing fragrance-free lip balms and regular
hydration every 2–3 h during breaks in non-contaminated areas.
5) Other skin reactions
Facial pigmentation has been reported by HCWs. It is likely to
be due to post-inflammatory hyperpigmentation or rarely, from
pigmented contact dermatitis (CD).3 Other facial PPE-related
dermatoses include seborrhoeic dermatitis, frictional dermatitis
and irritant contact dermatitis (ICD). Frictional dermatitis and
ICD can be caused by the mask or goggle linings and their
accompanying straps. Hyperhydration effects from the environ-
mental heat and humidity can exacerbate these facial protection
device-related dermatoses.
The straps of facial protection devices, including N95 masks,
can also cause abrasions or ICD on the external ear, especially
the root of the auricular helix.13 To prevent the latter, Lee et al
proposed a new design of respiratory masks with a dually split
head strap and a neck strap that avoids contact over the external
ear.17 While ear-independent masks is an option, another rec-
ommendation is to cover these areas with the surgical cap before
wearing the ear-dependent PPE,16 to minimize pressure from
the straps.
Rarely, allergic contact dermatitis (ACD) due to mask com-
ponents such as metal clips, rubber straps or adhesives in
these PPE devices can occur. Cases of ACD to thiuram in the
elastic straps of masks and rubber compounding materials
such as carba mix and acrylates in mask adhesives have been
reported.18–20 Dibromodicyanobutane, found in the adhesives
of surgical face masks, has also been reported to cause ACD
in a HCW.19 In terms of textile ACD, two HCWs developed
ACD to free formaldehyde and formaldehyde-releasing agents
found in the N95 masks during the SARS period.21 If occupa-
tional-related ACD is suspected, patch and skin prick tests
may be required and if confirmed, appropriate substitution
becomes necessary.
© 2020 European Academy of Dermatology and Venereology
592
Topical steroids can be applied to inflamed areas, and regular
emollients will help to protect the skin barrier from further dam-
age. Skin protectants such as silicone gel can be used to mini-
mize friction. All topicals should be applied at least 1 h before
donning PPE.
Skin reactions related to hand hygiene and gloves
1) Hand hygiene and irritant hand dermatitis
Hand hygiene is critical for the prevention of viral transmission.
However, the importance of rational hand hygiene needs to be
emphasized to all frontline HCWs.22 Overzealous hand hygiene
without regular hand protection and skin barrier repair will lead
to skin damage, creating a potential route of entry for COVID-
19. Hand hygiene exposes the skin to friction, rubbing, water,
surfactants and defatting chemicals which will compromise the
skin barrier, alter the hands’ microbial flora and cause ICD.23,24
84.6% of HCWs reported the hands as the most common site
affected in terms of PPE-related dermatoses.5 Majority washed
their hands more than 10 times/day, but only 22.1% applied
emollients after washing.
Alcohol-based hand rubs (ABHR) (>60% ethanol or 70% iso-
propanol) are recommended for HCWs and preferred to soap
and water unless there is visible soilage.25,26 ABHRs have been
shown to inactivate the virus, are more convenient and improve
compliance to hand hygiene amongst HCWs.25,26 They are also
known to cause less skin damage than hand washing, and gel
formulations have been shown to be better tolerated than liquid
formulations.27 Hand hygiene practices must be followed by skin
barrier repair through the judicious application of skin moistur-
izers.28 Application of emollients will not compromise the effi-
cacy of ABHRs and ceramide-containing moisturizers are
recommended.29 Accessories such as rings should not be worn at
work as irritants and chemicals may accumulate underneath
them during zealous hand hygiene practices.30
Topical corticosteroids and antibiotics are indicated for those
with clinical ICD and secondary infections respectively. More
importantly, the damaged skin should be given time even after
clinical clearance of skin inflammation, to recover fully before
resuming duties.
True allergic reactions to alcohol-based formulations are
uncommon.28 A HCW developed suspected ACD to iodopropynyl
butylcarbamate, found in a common brand of ABHRs.31 Cases of
ACD to isopropanol have been reported.32–38 A case series of 44
patients with positive patch tests to isopropanol revealed an 84%
relevance rate, and the authors suggested that sensitization to iso-
propanol is not that uncommon.38 However, it has been postu-
lated that these positive patch tests reactions are more likely toxic
skin reactions to 100% isopropanol rather than true allergic reac-
tions.39 Most other allergic reactions, if ever, are caused by other
excipients or preservatives in the ABHR.40 Tocopherol, fragrance,
propylene glycol, benzoates and cetyl stearyl alcohol were revealed
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Lee and Goh
as the top 5 allergens in a review of health care hand sanitizers.41
Patch tests can be done, and in the evaluation of isopropanol
allergy, this should be done with a dilution of 10% isopropanol, as
100% isopropanol in an occlusive patch test can possibly cause
toxic skin reactions that may be misinterpreted as a true allergy.39
With regard to alcohol-free hand rubs, these may contain a
quaternary ammonium compound known as benzalkonium
chloride (BAC). While it has been approved for the formulation
of hand rubs for HCWs, there is still limited data on the efficacy
of BAC against certain bacteria and viruses compared to that of
AHBRs.26,42 Furthermore, BAC is a well-known irritant, and in
some cases, a contact allergen.43,44 Found in many disinfectants
in the healthcare setting, it should also be considered in evalua-
tion of occupational contact dermatitis in HCWs, especially dur-
ing this pandemic.45
2) Glove-related skin reactions
Irritant contact dermatitis (ICD) Irritant contact dermatitis is
the most common skin reaction to wearing medical gloves
amongst HCWs. It is caused by the occlusive effects of gloves,
glove powder, soaps and incomplete hand drying before don-
ning gloves. (Fig. 3).
Double gloving has been reported to reduce the risk of viral
contamination during PPE removal.46 12.4% of HCWs reported
wearing three layers of gloves during shifts.6 We do not recom-
mend this for everyone, especially in the hot and humid climate
in the tropics. Prolonged occlusion and hyperhydration which
lead to skin maceration will compromise the skin barrier, mak-
ing the skin more vulnerable to irritation due to components of
the medical gloves. A single layer of latex gloves is adequate for
skin protection.5 An additional layer of gloves can be considered
in special circumstances where there is a potential breach in
Figure 3 Irritant contact dermatitis over the fingers in a HCW after
frequent hand washing and prolonged duration of wearing medical
gloves after a few weeks.
© 2020 European Academy of Dermatology and Venereology
Occupational Dermatoses from PPE during COVID-19 (Review)
hand PPE in the presence of pre-existing skin damage, heavy soi-
lage or torn gloves.
ACD to rubber chemicals (Type IV hypersensitivity reaction)
and True Latex Allergy (Type I hypersensitivity reaction) Latex
products composed of chemical accelerators and natural rubber
latex proteins (NRL) can cause glove-related occupational aller-
gic skin reactions.
Contact allergy to rubber additives in medical gloves is the
most common cause of occupational allergic hand dermatitis in
HCWs.47 These Type IV delayed hypersensitivity reactions are
caused by chemical accelerators such as thiuram and carbamates
and present as ACD. Patch testing is required for diagnosis.
‘True Latex allergy’, or immediate type I hypersensitivity reac-
tions to NRL can present with a spectrum of clinical manifesta-
tions ranging from contact urticaria to potentially life-
threatening anaphylaxis.48 The prevalence rate of latex sensitiza-
tion of 9.6% was reported amongst HCWs in Singapore.49 NRLs
present in the powder in medical gloves can be potential aeroal-
lergens, causing a systemic allergic reaction in latex-sensitive
individuals.50 Skin prick tests remain the gold standard for diag-
nosing type 1 latex allergy and should be done in the clinic or
hospital setting with necessary medical staff and latex-free resus-
citation equipment available.
While patch and skin prick tests remain the gold standard for
evaluation of ACD to rubber additives and latex allergy respec-
tively, these may not be feasible or easily accessible during this
ongoing pandemic. The use of non-powdered, reduced protein
and low-allergen latex gloves by all workers, and non-latex
gloves by sensitized individuals can decrease the rate of sensitiza-
tion in high-risk groups such as HCWs and reduce the rate of
NRL allergic reactions in sensitized groups.48,51 During SARS,
some HCWs improved after changing to latex-free gloves (nitrile
or vinyl), non-powdered latex gloves and wearing plastic or cot-
ton gloves beneath the latex gloves.3 These temporary measures
can be adopted until a review with a dermatology or occupa-
tional health clinic is available.
In the event of any of these skin reactions, topical steroids are
warranted for inflammation, and intensive emollients for skin
barrier repair. When using lipid-bearing emollients or barrier
creams on the hands, it is prudent to do this at least 1 h before
shift. HCWs should ensure the hands are completely dry before
donning PPE to avoid hyperhydration or occlusion that will pre-
cipitate skin damage. Avoid oil or petroleum-based hand creams
as they can cause glove deterioration. One must also remember
that contact allergy to constituents of emollients and barrier
repair cream may also occur.
Effects of tropical climate on the skin and gown-
related skin reactions
The high ambient temperatures in Singapore which range from
23–25°C (night) to 31–33°C (daytime) throughout the year and
JEADV 2021, 35, 589–596
593
mean annual relative humidity of 83.9% predispose our front-
line HCWs to skin reactions, maceration and skin barrier func-
tion damage.
Elston highlighted how common skin reactions could impact
an effective workforce in times of crises, citing the significant
reduction in military power because of skin diseases in tropical
Vietnam as a historical example.1
Heat injuries and thermal strain are occupational hazards that
should not be overlooked in HCWs working in the tropics.
Overheating has been commonly reported with all forms of PPE
amongst HCWs.52
Humidity, dust, increased temperatures and sun exposure are
known to increase the risk of skin inflammation such as atopic
dermatitis (AD).53–56 High humidity and heat result in excess
moisture accumulation on the skin protected by PPE, leading to
epidermal barrier disruption, inflammation and potential infec-
tions.
New-onset dermatitis or flares of pre-existing inflammatory
skin conditions like eczema and psoriasis can therefore present
in HCWs due to PPE. Profuse sweating, occlusive clothing, syn-
thetic non-absorbent clothing and friction are exacerbating fac-
tors for sweat-induced dermatitis, widely described in tropical
climates.57–59 (Fig. 4).
Hyperhidrosis itself has been known to worsen pruritus and
cause skin irritation.55,60,61 The acidic pH of sweat promotes
Th2 and Th17-mediated inflammation, with subsequent down-
regulation of filaggrin expression.62 Higher temperatures induce
cutaneous vasodilatation and stimulation of C nerve fibres, caus-
ing pruritus.62 Malassezia globosa has been found to be respon-
sible for producing the main histamine-releasing antigen in
human sweat, exacerbating cholinergic urticaria and AD.63 Dis-
comfort from hyperhidrosis will also affect PPE compliance and
can cause ICD over the areas covered by PPE.6 Any area covered
Figure 4 Eczema flare over the neck exacerbated by perspiration
and friction from the disposable gown in an outdoor screening
centre.
© 2020 European Academy of Dermatology and Venereology
594
Figure 5 (a) Flare of sebopsoriasis over the occiput exacerbated
by perspiration and occlusion under the surgical cap. (b) Intertrigo
in the toe webspaces after 1 month of working in a hot and humid
environment. The HCW self-medicated with no improvement,
eventually requiring a formal dermatology consult.
by PPE is therefore vulnerable to hyperhydration effects, from
the scalp to the toes. (Fig. 5a,b).
Surgical caps can cause itch, folliculitis and aggravate sebor-
rhoeic dermatitis. The high ambient temperature and humidity
in tropical countries including Singapore also predisposes indi-
viduals to skin conditions such as miliaria, cholinergic urticaria
and superficial fungal infections.
Free formaldehyde and formaldehyde textile resins (FTR)
may be present in hospital uniforms and non-woven fabric in
disposable gowns and masks. These can all cause textile ACD in
HCWs, which can be exacerbated by friction, heat, moisture
accumulation due to perspiration, and restrictive or occlusive
clothing. A HCW was found to have textile ACD to FTRs in N95
masks and scrubs during the SARS epidemic.21
Healthcare workers should be given frequent breaks to hydrate
themselves during work. It is recommended that they wear thin,
cool, moisture-wicking garments beneath the PPE gowns to miti-
gate the heat and humidity. Non-contaminated areas where
HCWs take breaks should be well ventilated with cooling devices
available. Non-sedating antihistamines can be taken for cholinergic
urticaria or intense pruritus. Mild topical steroids and topical anti-
fungals can be used for miliaria and superficial fungal infections
respectively. Flares of AD, CD, psoriasis and seborrhoeic dermati-
tis should be managed with topical steroids, emollients and trigger
avoidance. Patch tests should be done if textile ACD is suspected.
To protect the skin barrier, we recommend gentle soap-free
cleansers, and regular application of moisturizers before and
after shifts and as frequently as possible when at home, especially
after showering.
For practical reasons, scalp hair should be kept short to facili-
tate adequate protection by surgical caps to avoid hair contami-
nation. This also allows easy decontamination and cleansing. It
also reduces the chance of moisture accumulation and occlusion
under the surgical caps.
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Lee and Goh
Presence of facial hair can predispose one to mask-related
dermatoses such as acne, folliculitis and ICD. Thick facial hair
may compromise the fit and integrity of N95 masks.64,65 Regular
shaving and cleansing are advised.
Conclusion
The safety of HCWs should not be compromised, and by pre-
venting PPE-related dermatoses, we also maintain the integrity
of PPE and its protective nature to mitigate the transmission of
COVID-19.
It is important to have comprehensive guidelines on pre-
vention and management of PPE-related dermatoses in
HCWs. The recommendations must also take into considera-
tion the environmental factors and conditions at the sites of
deployment for HCWs. While climate factors such as temper-
ature, humidity and sun exposure are non-modifiable, other
methods can be adopted to make the environment more con-
ducive for frontline HCWs. Prolonged use of PPE due to
long shift duties are a major risk factor for these skin reac-
tions. We recommend shifts of about 5-6 h, with mandatory
breaks every 2–3 h to allow relief of pressure from facial pro-
tection devices where possible and to mitigate the risks of
other adverse skin reactions as discussed. HCWs should be
reminded to hydrate themselves as frequently as possible. Rest
areas in non-contaminated areas should be made easily acces-
sible for HCWs, with good ventilation and cooling devices.
While we have provided recommendations on prevention and
management, severe or intractable cases should still seek advice
from a dermatologist. Occupational skin diseases, including
occupational allergic skin reactions, have a significant impact on
HCWs and must not be neglected. Contact dermatitis and occu-
pational dermatology clinics should remain operational during
the time of the pandemic to cater to the needs of our frontline
HCWs. The benefits of ‘virtual’ occupational skin health clinics
for HCWs during this pandemic have been discussed.66 While
we have highlighted the importance of making ourselves avail-
able to our patients and the community via teledermatology
during this period, we should not forget fellow HCWs working
on the frontline. Physical or teledermatology consultations can
be made more accessible to all frontline HCWs, especially those
with pre-existing skin conditions prior to the pandemic. Special
arrangements can be made to accommodate frontline HCWs
and their variable working hours.
It is important to remember that the fight against the
COVID-19 pandemic is not only a nationwide effort for each
country, but that of a global one. More definitive data on pre-
vention strategies for PPE-related dermatoses will help in the
current fight, if not the future.
Acknowledgement
The patients in the manuscript have given written informed con-
sent to publication of their case details.
© 2020 European Academy of Dermatology and Venereology
Occupational Dermatoses from PPE during COVID-19 (Review) 595

Author Contribution 20 Hamann CP, Rodgers PA, Sullivan K. Allergic contact dermatitis in dental
professionals: effective diagnosis and treatment. J Am Dent Assoc 2003;
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preparation of this manuscript and have taken due care to 21 Donovan J, Skotnicki-Grant S. Allergic contact dermatitis from formalde-
ensure its integrity. hyde textile resins in surgical uniforms and nonwoven textile masks. Der-
matitis 2007; 18: 40–44.
22 Singh M, Pawar M, Bothra A, Choudhary N. Overzealous hand hygiene
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