The COVID-19 pandemic has impacted the entire world, and many countries have been devastated by the fallout. As this virus swept the world, it has not only changed many aspects of the global economy but also has transformed the way we live our everyday lives.
The skin is one of the major body parts that have been impacted by the coronavirus. It’s apparent that frequent usage of personal protective equipment and excessive personal hygiene could trigger different skin conditions. These skin conditions include rashes, perioral dermatitis, skin pigment change, pressure urticaria, and worsening of pre-existing skin issues like chronic dermatitis, acne and skin wrinkles.
The changes brought about by the coronavirus pandemic could undoubtedly have a physical impact on our skin, but they can also affect us on an epigenetic level. Epigenetics is the study of heritable modifications that affect gene expression without affecting the underlying DNA sequence, and it plays a large role in skin health.
Skin issues during the pandemic
Epigenetic changes naturally occur as you age, and as your skin is exposed to different environments. Face masks have now become a part of our everyday lives. Increasing evidence shows that wearing face masks can reduce the risk of transmitting the disease, as they help to prevent the spread of droplets from the mouth and nose (2). However, those who need to wear face masks for long hours might suffer from skin irritation. In fact, many frontline health care workers are facing terrible skin conditions due to the prolong contact with surgical masks.
According to Drs. Darlenski and Tsankov from Tokuda Hospital in Bulgaria, “Long time usage of masks and goggles may cause a variety of cutaneous diseases, ranging from contact and pressure urticaria or contact dermatitis to aggravation of preexisting dermatitis. About one-third of health care workers complained of acne, facial itching, and even dermatitis from wearing an N95 mask”(1). Some potential side effects that we must consider include:
- Itchy rashes: a type of irritant contact dermatitis, which can happen when the skin is exposed to frequent wet-dry situations.
- Perioral dermatitis: As masks get damp from sweat, vapor or moisture it can cause skin irritation, leading to rashes and redness.
- Changes in skin pigment: Skin pigment might change as a result of excessive rashes, resolving rashes, and repetitive friction.
- Pressure urticarial: Wearing a mask for long periods of time can not only cause nose and ear discomfort but can also cause an allergic skin reaction that usually cause itching, burning or stinging on skin’s surface (3).
Handwashing is especially important to reduce the spread of coronavirus, but ironically, excessive hygiene can cause dry, irritated skin. Drs. Darlenski and Tsankov also add: “exaggerated handwashing with detergents/disinfectants can impair the hydrolipid mantle of the skin surface and may also be responsible for irritation and even the development of contact dermatitis” (1). This could lead to itching, peeling, cracking, and even prolonged bleeding. The open wounds that these side effects can cause could leave a person susceptible to dirt, bacterial, and other foreign materials—which all could increase the risk of infection(4).
Social isolation has recently transformed our lives in so many ways. One major way is the increased time being spent in front of a phone or TV screen. Our smartphones and computers have become a portal to the outside world through this time of quarantine.
Increased time spent with our devices means more exposure to blue light, which not only causes stress for the eyes but also can be harmful to our skin. Studies have shown that blue light can cause increased pigmentation and generation of free radicals via decreasing carotenoids in human skin. It has also been observed to cause inflammation, wrinkles, premature aging, and a breakdown of collagen (5).
Additionally, the increased time spent looking at our phones could have a lasting impact on our facial muscles, and result in wrinkles: ‘If you find yourself squinting or furrowing your eyebrows when staring at your screen, this movement is produced by contraction of the muscles, which makes the skin wrinkle,’ explains Turnham, from Grazia Middle East (6). “These wrinkles aren’t permanent, but if you repeat the same facial movements frequently, the muscles become bigger and stronger, and over time those movement wrinkles will become more pronounced”.
Epigenetics and skin
Environmental factors can affect epigenetic modifications like DNA methylation, histone modifications and microRNA expression. These modifications can directly impact gene expression, as genes can be activated/deactivated in response to a stimulus, habitat, diet, or other factors. Because these changes can be inherited from one generation to the next, the health of skin and other organs can be greatly impacted.
In a 2014 study from Icahn School of Medicine at Mount Sinai, Dr. Carolina Perdigoto and her team discussed the role of epigenetics in skin control and the relationship with skin pathologies. In psoriasis, a chronic inflammatory skin disease, the hypermethylation and resulting down-regulation of p16INK4A seems to be more prevalent in severe lesions than in non-affected skin areas(8).
In atopic dermatitis, another complex skin disease characterized by chronic and severe itching, the levels of DNMT1 seem to be lower when measured in the blood of affected patients suggesting that DNA methylation levels may contribute to the pathogenesis of this disease. According to their results, epigenetic regulators can modify proliferation and differentiation in skin cells.
Another study by Drs. Sangjo Kang and Gopal Chovatiya from Cornell University showed that epigenetics could potentially modify tissue regeneration via controlling skin cell development and homeostasis. Their conclusion suggested tissue regeneration depends upon our ability to control cell fate decisions of adult tissues by modifying their genome plasticityand their crosstalk with the environment. Specialized epigenetic states throughout the genome and overall levels of covalent histone modifications (e.g., acetylation, methylation) appear to impact skin cell fates in development, adult tissue homeostasis and injury repair (9).
Lifestyle plays a part in epigenetic and skin
As the COVID-19 pandemic could change the way we live our daily lives in the future, we should be conscious that these new lifestyle changes may leave us susceptible to epigenetic change. During the pandemic, most people have experienced skin issues as a result of safety protective methods like constantly wearing a mask, and frequent hand washing/sanitizing. It would be helpful for us to stay hydrated and replace face masks as often as possible.
The ability to measure the epigenetic changes associated with lifestyle and environmental risk factors can be used to help determine preventive and proactive healthcare. It could also be useful to identify the epigenetic health of skin and help to monitor the dynamic way the skin changes in response to environment so that the best-suited skincare products or regimens could be selected.
1. Darlenski, R., & Tsankov, N. (2020). COVID-19 pandemic and the skin: what should dermatologists know?. Clinics in Dermatology.
2. Chu, Derek K, et al. (2020). Physical Distancing, Face Masks, and Eye Protection to Prevent Person-to-Person Transmission of SARS-CoV-2 and COVID-19: a Systematic Review and Meta-Analysis. The Lancet, 395(10242), 1973–1987.
3. eHealth Network. COVID-19 Pandemic: Safety Guide to Wear Face Mask. EHealth Magazine. 13 June 2020. Web.
4. “Dry Skin Relief from COVID-19 Handwashing.” American Academy of Dermatology, 2020. Web.Vandersee, Staffan, et al. (2020).
5. Blue-Violet Light Irradiation Dose Dependently Decreases Carotenoids in Human Skin, Which Indicates the Generation of Free Radicals. Oxidative Medicine and Cellular Longevity. 2015. 1–7
6. “Do You Have Lockdown Face?” Grazia Middle East, 2020. Web.
7. “Epigenetics: Fundamentals, History, and Examples.” What Is Epigenetics?, 2013. Web.
8. Perdigoto, C. N., et al. (2014). Epigenetic Regulation of Epidermal Differentiation. Cold Spring Harbor Perspectives in Medicine. 4(2).
9. Kang, Sangjo, et al. (2019). Epigenetic Control in Skin Development, Homeostasis and Injury Repair. Experimental Dermatology.
10. “Epigenetics: How the Environment Influences Our Genes.” Encyclopedia of the Environment, 30 Oct. 2019. Web.
11. Alegría-Torres JA, et. al. (2011) Epigenetics and lifestyle. Epigenomics. 2011;3(3):267-277