Sensitive skin is a condition where the skin has a reduced tolerance to cosmetics and personal care products, often resulting in stinging, burning, or itching. The COVID-19 pandemic introduced new challenges for individuals with this condition. Public health measures and the illness itself created circumstances that could impact skin health in multiple ways.
Cutaneous Manifestations of a COVID-19 Infection
A COVID-19 infection can present in various ways on the skin, known as cutaneous manifestations. Researchers documented a range of skin-related issues in patients, thought to be a direct result of the body’s inflammatory response to the SARS-CoV-2 virus or its impact on blood vessels. These skin signs can appear before, during, or after other COVID-19 symptoms, and are sometimes the only sign of infection.
One frequently reported pattern is a morbilliform (measles-like) rash with widespread red spots. Another common presentation is urticaria, or hives, which appears as itchy, raised welts on the skin. Some patients develop vesicular eruptions, which are small, fluid-filled blisters that resemble chickenpox.
A widely discussed phenomenon was the appearance of chilblain-like lesions, often called “COVID toes.” These lesions present as reddish-purple, swollen patches on the toes and, less commonly, the fingers. They can be itchy or painful and tend to appear late in the disease, often in younger patients with milder symptoms.
Effects of Personal Protective Equipment on Skin
The use of personal protective equipment (PPE) introduced mechanical and chemical challenges for the skin. Face masks create an enclosed microenvironment that traps warm, moist air from breathing. This environment, combined with physical pressure and friction, can lead to a type of acne known as acne mechanica, or “maskne.”
Acne mechanica results from the blocking of hair follicles. The rubbing of the mask irritates follicles, while trapped heat and humidity increase oil and sweat, creating conditions for bacteria to multiply. This leads to breakouts on the nose, cheeks, and chin.
The materials and fit of masks can also cause contact dermatitis, an itchy rash resulting from a reaction to the fabric or its manufacturing chemicals. Constant friction can lead to chafing and sores, especially over the nose or behind the ears. Increased hand hygiene, including frequent washing and sanitizing, strips the skin of its protective oils, leading to dryness, cracking, and hand eczema.
Stress-Induced Skin Conditions During the Pandemic
The psychological toll of the pandemic also had a measurable impact on skin health. Pandemic-related anxiety, uncertainty, and social isolation contributed to an increase in chronic stress, which has direct biological consequences for the skin.
When the body experiences stress, it releases hormones like cortisol, which promotes inflammation throughout the body. This systemic inflammation can aggravate pre-existing sensitive skin conditions. For individuals with rosacea, this can mean more frequent and intense flushing and redness.
People with eczema or psoriasis often experience flare-ups during high stress, as increased inflammation triggers itchy, scaly patches. The rise in cortisol can also stimulate the skin’s oil glands, contributing to acne breakouts independent of mask-wearing.
Strategies for Supporting the Skin Barrier
Maintaining a healthy skin barrier is fundamental for managing sensitive skin. The skin barrier is the outermost layer, composed of cells and lipids that form a protective wall to keep moisture in and irritants out. When this barrier is compromised, the skin becomes more susceptible to irritation and dehydration.
To support the barrier, use gentle, non-soap cleansers. Harsh soaps can strip essential lipids, so cleansers with a pH between 4.0 and 5.0 are preferable as they are closer to the skin’s natural state. After cleansing, applying moisturizer to damp skin helps lock in hydration.
Certain ingredients can help repair the skin barrier. Ceramides are lipids that replenish the skin’s own supply. Humectants like glycerin and hyaluronic acid draw moisture into the skin, improving its resilience. Using moisturizers that combine these elements can effectively support the skin’s protective capabilities.