The photos sent back from the front line of the fight against COVID-19 are heartbreaking. When medical staff have been working in the isolation ward for a long time, facial indentation and even pressure skin damage can be seen on their faces because of wearing N95 masks.

Why do their faces get damaged from masks?

What makes N95 masks effective is the complete air tightness as they are fastened to the face by the pressure of the rubber band. 

Due to the protuberance of the nasal bone, the metal pressure sheet lined with soft cushion forms complete air tightness, ensures that the air outside cannot be inhaled easily, so as to ensure that microorganisms and microparticles can be isolated during breathing.

Generally, skin damage will not be caused when wearing a mask for four hours due to the certain degree of elasticity in the mask band and nose gasket. But front line medical workers often wear masks for more significantly longer, resulting in the facial indentation seen in many photos. 

In the early stage, after removing the mask, the skin is sunken or indented, but if the same part is pressed day after day, especially in the nose, zygomatic and other parts with less subcutaneous tissue are prone to suffer from damage and ulceration, and this can be aggravated in a humid environment.

How can skin damage from the mask be prevented?

1. Precautions before wearing a mask:

(1) Keep your skin clean. Before wearing a mask, gently clean the skin with water or neutral cleansing supplies, and then rinse.

(2) Dry the skin gently and then apply a small amount of baby lotion or similar products.

(3) It is recommended that cosmetic products such as foundation shouldn't be worn before putting on a mask, as they contain tiny particles, leading to local pore blockage.

2. Carefully adjust the position of the mask every day. If possible, slightly change it every day.

3. After daily work:

(1) Wash your face with water after removing the mask. If the skin is slightly red, it is recommended to wash your face with mineral or clear water. The temperature should be between 20 and 40℃.

(2) Gently massage the face with moisturizer. Baby lotion is recommend and it is very important to clean your hands before touching your face. 

Be sure to trim your nails and wash your hands carefully.

What should we do if the marks don't go away, or become swollen?

1. If the red indentation doesn't fade after 10 minutes, improve local blood circulation after the above-mentioned facial skin cleaning. 

At this point, if there are only indentations and the skin is intact, using Mucopolysaccharide Polysulfate Cream or Low Molecular Weight Heparin Sodium Gel that can improve local blood circulation. Massage three to four times a day after removing the mask.

2. In case of swelling, after the above treatment, local anti-infection treatment should be applied in time to prevent skin damage from becoming worse.

Important tips for preventing and treating skin damage:

It is necessary to treat face damage as early as possible.

1. First, clean the wound with water. At present, a large number of studies have pointed out that there is no difference between the ability of cleaning the wound with flowing water and removing bacteria with disinfectants.

2. It is important to use local anti-infection treatment after cleaning. As the common bacteria on the face is gram-positive bacteria, it is recommended to use ointments such as Mupirocin. This kind of ointment can prevent and treat facial infection, and the moisturizing effect of the ointment can also help the skin heal.

It is generally recommended disinfectants such as iodophor or alcohol should not be used when skin damage occurs unless there is a risk of virus exposure, since they may cause skin cell damage. 

Therefore, normal saline should be first applied for cleaning after washing with water. Apply antibacterial ointment after the cleaning and the wound should heal in a short time.

Stories in this series were contributed from Tencent Medpedia medical team, which were written and reviewed by medical experts from China's top hospitals. They are intended for informational purposes only, not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on our website. If you think you may have a medical emergency, immediately call your doctor, or go to the hospital.