8 Tips to Avoid Skin Damage While Wearing PPE

Masks, goggles, and other protective equipment were never built for full shifts, let alone the reuse that supply shortages forced during the pandemic. The result was widespread facial marks, bruising, and broken skin among frontline staff. Here is how to protect your skin.

Skin problems caused by PPE

A study in the Journal of the American Academy of Dermatology found that 97% of staff (526 of 542 surveyed) across two COVID-19 units reported PPE-related skin damage, with the risk climbing when PPE was worn continuously for more than 6 hours, especially N95 masks and goggles.

Facial damage comes mainly from sustained pressure, trapped moisture, and chafing. The bridge of the nose is hit hardest because it is a bony prominence with little soft tissue under the skin. The cheekbones, the forehead under a shield, and the backs of the ears from mask elastics are also common sites, along with acne outbreaks. Staff have reported eczema and dermatitis on the hands from constant hand cleaning and prolonged glove use. Heat, sweat, and poor air circulation under gowns cause redness, rashes, and irritation in skin folds, similar to nappy rash, which can progress to secondary bacterial or fungal infection.

1. Moisturize regularly

After your shift, wash your face and neck, pat the skin dry rather than rubbing, and apply a good moisturizer. Moisturize before donning PPE too, since it needs time to absorb, so getting ready for work is a good window. Only 22% of healthcare workers apply hand cream regularly after washing. Dry your hands well, apply cream before gloving up, and wash and moisturize again as soon as the gloves come off.

2. Check that your mask fits

Most mask-related skin problems come from a mask that is fitted wrong or sitting badly. Take your time putting it on, make sure it is neither too loose nor too tight, and adjust it before you step out to patients. N95s should be fit-tested, and you should wear only the model that fits you. Replace any mask the moment it gets wet, soiled, or genuinely uncomfortable.

3. Relieve pressure regularly

Take your mask, goggles, and face shield off at least every 4 hours when possible. Even a few minutes of restored blood flow can prevent lasting damage.

4. Use a barrier cream

A barrier cream adds protection during long PPE stretches, and it matters most if you already have underlying damage, like redness that lingers after you remove PPE or visible bruising. Apply a product such as dimethicone to the areas most affected. These seal the skin against moisture and friction, some come as wipes, and you should let them dry for about a minute before donning PPE.

5. Apply dressings when needed

Protective, moisture-absorbing dressings between your skin and pressure or friction points help when the skin is already broken. Clear it with your infection control department first to confirm the dressing won't compromise the PPE seal and fits your employer's protocol. You may need a refit if you use one under a fitted respirator. The Nurses Specialized in Wound, Ostomy, and Continence guidelines outline dressing types and cutting patterns for different parts of the face.

6. Protect your ears

To spare the backs of your ears from irritation or ulceration from mask elastics, hook the loops onto buttons on a cap or headband. Just make sure this doesn't pull the mask tighter and add pressure to your face. Surgical masks that tie behind the head tend to irritate less, so choose those if you have the option.

7. Manage heat rashes

Wearing a gown all day can trap sweat in skin folds and cause intertriginous dermatitis, a red, itchy rash. Prevent it by drying off well after bathing, avoiding tight or chafing clothing, and wearing moisture-absorbing underwear. Talcum powder or corn starch helps keep the area dry. Early on, a barrier cream protects the skin. If it gets infected you will need a prescription antibiotic or antifungal ointment, possibly with a mild topical steroid.

8. Stay hydrated

Drink plenty of water on breaks and before and after work. Dry skin irritates and breaks down more easily, the same way lips chap in winter.

Take care of your skin

Even minor PPE irritation raises your infection risk, because you touch your face and adjust your mask more when it bothers you, and broken skin is an entry point for the virus and other infections. Report any broken skin to your supervisor and file an incident form, and see your healthcare provider if it gets worse.