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Pigmentary Changes on Facial Mask-covered Area: is it Related to Alteration of Microenvironment in the Era of COVID-19?

Abstract



Keywords



Cutinebacterium Facial mask Hypopigmention Progressive macular hypomelanosis



A 61-year-old male patient presented with hyper- and hypo-pigmented finely scaled macules (Fig. 1A, B). He had recently started training at the indoor gym, wearing a facial mask for more than 2 hours a day, during exercise, without replacement. The potassium hydroxide mount of the skin scrapping revealed short hyphae and spores, leading to a provisional diagnosis of tinea versicolor (TV), but topical anti- fungal medications failed to work. Additionally, Wood's lamp examination did not show any characteristics of vitiligo (Fig. 1C, D). Combination treatment with topical tacrolimus and excimer laser was introduced under the suspicion of progressive macular hypomelanosis (PMH) and achieved a partial resolution.

Figure 1. (A, B) Hypopigmented and hyperpigmented asymptomatic, scaly patches were seen on both cheek which is covered by facial mask. (C, D) There was no fluoresce and accentuation of hypopigmented lesion under the light of a Wood's lamp.

The bacterial community composition of the facial skin was dominated by lipophilic Cutibacterium species, whereas the fungal community by Malassezia1. TV caused by Malassezia usually occurs on the trunk in a warm and humid environment. PMH is commonly seen on the trunk but rarely on the face because of the absence or low abundance of C. acnes type III2.

Continuous use of face masks increases temperature, humidity, and sebum secretion in the covered area3 leading to alterations in the skin microbiome. Thus, the microenviron- ment of the area under the mask appears analogous to the trunk covered with clothing. Furthermore, facial PMH occurs in old age, indicating that the distribution of C. acnes type III could vary with age2.

This study suggests the inclusion of TV and PMH when diagnosing patients for pigmentary changes due to the alterations in the facial skin microenvironment in the era of the COVID-19 pandemic.



References


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