Impact of Prolonged Use of Face Masks on Nasal and Skin Microbiota among Healthcare Workers and Related Populations: A Systematic Review and Exploratory Meta-Analysis

Sowmya Nasimuddin; Giyo Selvaraj Vasanthakumari; Fahad Affan Tajir; Shaikh Mohammad Haroon al Waseem; Kiran Madhusudhan

doi:10.11910/j.issn.2791-2043.2025.4.04

Your Location：

Home >

Browse articles >

Impact of Prolonged Use of Face Masks on Nasal and Skin Microbiota among Healthcare Workers and Related Populations: A Systematic Review and Exploratory Meta-Analysis

REVIEW ARTICLES | Updated：2026-05-22

- Impact of Prolonged Use of Face Masks on Nasal and Skin Microbiota among Healthcare Workers and Related Populations: A Systematic Review and Exploratory Meta-Analysis
- Sterile Supply Vol. 4, Issue 4, (2025)
- Affiliations：
  
  Sri Muthukumaran Medical College Hospital and Research Institute
- Author bio：
  
  Sowmya Nasimuddin
- Funds：
- DOI：10.11910/j.issn.2791-2043.2025.4.04
  CLC：
- Published：15 December 2025
- Accepted：
Scan QR Code
Nasimuddin Sowmya,Vasanthakumari Giyo Selvaraj,Tajir Fahad Affan,et al.Impact of Prolonged Use of Face Masks on Nasal and Skin Microbiota among Healthcare Workers and Related Populations: A Systematic Review and Exploratory Meta-Analysis[J].Sterile Supply,2025,04(04):259-265.
DOI：

Nasimuddin Sowmya,Vasanthakumari Giyo Selvaraj,Tajir Fahad Affan,et al.Impact of Prolonged Use of Face Masks on Nasal and Skin Microbiota among Healthcare Workers and Related Populations: A Systematic Review and Exploratory Meta-Analysis[J].Sterile Supply,2025,04(04):259-265. DOI： 10.11910/j.issn.2791-2043.2025.4.04.

摘要

Abstract

Background

Prolonged face mask use is an essential occupational safety measure for healthcare workers (HCWs)

especially during the COVID-19 pandemic. While mask wearing effectively reduces exposure to respiratory pathogens

extended use creates a warm

humid

and occlusive microclimate that may disrupt the nasal and facial skin microbiota

potentially affecting comfort

barrier function

and occupational well-being. This systematic review aimed to synthesize primary research evidence on the impact of prolonged face mask use on the nasal and facial skin microbiota among HCWs and related population.

Methods

A systematic review with an exploratory meta-analysis was conducted following the PRISMA 2020 statement. Searches were performed in PubMed

Scopus

and Web of Science for studies published between January 2000 and December 2025. Inclusion criteria were observational and interventional studies involving HCWs or related populations exposed to at least four hours of mask use per day

with nasal or facial skin microbiota as an outcome. Due to heterogeneity in study methods

findings were narratively synthesized.

Results

A total of eleven primary studies met the inclusion criteria: four examined nasal microbiota

and eight examined facial skin microbiota. Consistent evidence indicated that prolonged mask use (4 to 12 hours per day) was associated with reduced microbial diversity. Nasal microbiota analyses revealed increased relative abundance of

Staphylococcus and Corynebacterium

species and decreased commensal

species. On facial skin

reduced microbial diversity and dominance of

Cutibacterium

species were observed

particularly among individuals with mask-related dermatological symptoms. An exploratory meta-analysis of four studies showed no significant decrease in microbial diversity

with high heterogeneity (

70%).

Conclusion

This synthesis of eleven studies indicates that prolonged mask wearing is associated with localized alterations in the microbiota

primarily affecting facial skin and nasal microbial communities. These changes likely represent ecological adaptations to humidity and occlusion rather than clinically harmful dysbiosis.

关键词

Keywords

references

GANESAPILLAI M , MONDAL B , SARKAR I , et al . The face behind the Covid-19 mask—a comprehensive review [J ] . Environmental Technology & Innovation , 2022 , 28 : 102837 .

HUMAN MICROBIOME PROJECT CONSORTIUM . Structure, function and diversity of the healthy human microbiome [J ] . Nature , 2012 , 486 ( 7402 ): 207 - 214 .

BELKAID Y , HAND T W . Role of the microbiota in immunity and inflammation [J ] . Cell , 2014 , 157 ( 1 ): 121 - 141 .

KONG H H , SEGRE J A . Skin microbiome: Looking back to move forward [J ] . Journal of Investigative Dermatology , 2012 , 132 ( 3 ): 933 - 939 .

MAN W H , DE STEENHUIJSEN PITERS W A A , BOGAERT D . The microbiota of the respiratory tract: Gatekeeper to respiratory health [J ] . Nature Reviews Microbiology , 2017 , 15 ( 5 ): 259 - 270 .

FLUHR J W , DARLENSKI R , TAIEB A , et al . Functional skin adaptation in infancy–almost complete but not fully competent [J ] . Experimental Dermatology , 2010 , 19 ( 6 ): 483 - 492 .

ZHAI H B , MAIBACH H I . Effects of skin occlusion on percutaneous absorption: An overview [J ] . Skin Pharmacology and Physiology , 2001 , 14 ( 1 ): 1 - 10 .

XIANG G X , XU K , JIAN Y , et al . Prolonged mask wearing changed nasal microbial characterization of young adults during the COVID-19 pandemic in Shanghai, China [J ] . Frontiers in Immunology , 2023 , 14 : 1266941 .

MERENSTEIN C , FITZGERALD A S , KHATIB L A , et al . Effects of mask reuse on the oropharyngeal, skin, and mask microbiome [J ] . The Journal of Infectious Diseases , 2023 , 228 ( 4 ): 479 - 486 .

PARK A M , KHADKA S , SATO F , et al . Bacterial and fungal isolation from face masks under the COVID-19 pandemic [J ] . Scientific Reports , 2022 , 12 : 11361 .

LEE Y H , KIM H , HEO D W , et al . Oral microbiome of the inner surface of face masks and whole saliva during the COVID-19 pandemic [J ] . Frontiers in Oral Health , 2023 , 4 : 1178020 .

ZHANG J X , JIANG P Y , ZHANG Y X , et al . Effects of wearing masks during COVID-19 pandemic on the composition and diversity of skin bacteria and fungi in medical workers [J ] . Frontiers in Microbiology , 2023 , 14 : 1274050 .

ZHONG S M , LAI Y Y , NA J , et al . Mask wearing impacts skin barrier function and microbiome profile in sensitive skin [J ] . Scientific Reports , 2024 , 14 : 24209 .

AU S , BARANIYA D , DAO J , et al . Prolonged mask wearing does not alter the oral microbiome, salivary flow rate or gingival health status—A pilot study [J ] . Frontiers in Cellular and Infection Microbiology , 2022 , 12 : 1039811 .

WONGTADA C , PUARATANA-ARUNKON T , PROMBUTARA P , et al . New normal mask-wearing and its impact on underneath skin microbiome: A cross-sectional study in mild acne vulgaris patients [J ] . Skin Appendage Disorders , 2022 , 8 ( 5 ): 376 - 381 .

DENG K X , TONG X F , CHEN S Y , et al . Exploration of the changes in facial microbiota of maskne patients and healthy controls before and after wearing masks using 16 S rRNA analysis [J ] . Journal of Epidemiology and Global Health , 2024 , 14 ( 3 ): 947 - 961 .

HUA W , ZUO Y , WAN R Y , et al . Short-term skin reactions following use of N95 respirators and medical masks [J ] . Contact Dermatitis , 2020 , 83 ( 2 ): 115 - 121 .

KISTOWSKA M , MEIER B , PROUST T , et al . Propionibacterium acnes promotes Th17 and Th17/Th1 responses in acne patients [J ] . Journal of Investigative Dermatology , 2015 , 135 ( 1 ): 110 - 118 .

LEE Y B , BYUN E J , KIM H S . Potential role of the microbiome in acne: A comprehensive review [J ] . Journal of Clinical Medicine , 2019 , 8 ( 7 ): 987 .

FOO C C I , GOON A T J , LEOW Y H , et al . Adverse skin reactions to personal protective equipment against severe acute respiratory syndrome—a descriptive study in Singapore [J ] . Contact Dermatitis , 2006 , 55 ( 5 ): 291 - 294 .

LAN J J , SONG Z X , MIAO X P , et al . Skin damage among health care workers managing coronavirus disease-2019 [J ] . Journal of the American Academy of Dermatology , 2020 , 82 ( 5 ): 1215 - 1216 .

TECHASATIAN L , LEBSING S , UPPALA R , et al . The effects of the face mask on the skin underneath: A prospective survey during the COVID-19 pandemic [J ] . Journal of Primary Care & Community Health , 2020 , 11 : 2150132720966167 .

GEFEN A , OUSEY K . Update to device-related pressure ulcers: SECURE prevention. COVID-19, face masks and skin damage [J ] . Journal of Wound Care , 2020 , 29 ( 5 ): 245 - 259 .

SHARMA P , GOEL N , DOGAR K , et al . Adverse skin reactions related to PPE among healthcare workers managing COVID-19 [J ] . Journal of the European Academy of Dermatology and Venereology , 2021 , 35 ( 8 ): e481 - e48

Views

Downloads

CSCD

Alert me when the article has been cited

Submit

Tools

Publicity Resources

Hygienic requirements for automated washer-disinfector for endoscope

A Custom-made Drying Rack for Precision Microsurgical Instruments: Design and Clinical Application

Application Progress and Effectiveness of Information Traceability Systems in Loaner Instrument Management

Dual-Robot Collaborative Automated Sterile Pack Storage System for the Central Sterile Supply Department: Design and Performance Validation

Critical Node Control Combined with a Fully Automatic Dental Cleaning Machine for Cleaning and Disinfection of Dental Handpieces

Related Author

No data

Related Institution

No data

⁰