Factors aggravating acne vulgaris during the COVID-19 pandemic in China: a web-based cross-sectional survey

Acne vulgaris is a common skin disease worldwide. Throughout the COVID-19 pandemic, many patients with acne complained of worsening symptoms. This investigation was designed to survey the impact of COVID-19 regulations on acne and guide patients with acne on symptom management during the pandemic.

From April 7th to April 21st, 2020, an anonymous, self-completed, web-based questionnaire was distributed to patients previously diagnosed with acne (via the Chinese internet medical software). Information collected included patients' mask-wearing routines and behavioral factors including dietary habits, sleep habits, facial hygiene, and make-up use habits.

508 qualified questionnaire responses were collected. During the COVID-19 outbreak in China, there was an overall worsening of patients' acne symptoms (152, 29.9%). Behaviors including intake of sweets (34.9% vs. 16.0%, p<0.01), dairy consumption (32.9% vs. 23.3%, p<0.05), greasy (19.1% vs. 11.2%, p<0.05) and spicy food intake (30.3% vs. 14.3%, p<0.01) and mask-wearing frequency (>28 hours per week) (25.0% vs. 15.3%, p<0.05) presented a statistically significant difference between the acne aggravated and non-aggravated groups. Longtime mask-wearing (>28 hours per week), rather than the mask type, was significantly associated with acne symptom deterioration during the COVID-19 outbreak (odds ratio [OR]: 2.164; 95% confidence interval [CI]: 1.232-3.801).

Besides the well-known risk factors, such as sweets intake, dairy consumption, and greasy and spicy food intake, wearing masks appears to trigger or aggravate acne during the COVID-19 pandemic. Limiting overall mask-wearing time may help to manage acne.