Ear-looped face masks associated retro-auricular abscesses during the COVID-19 pandemic

Universal mask-wearing has become public-health recommendations and a necessity in daily life since coronavirus disease 2019 (COVID-19) pandemic. Accumulating evidence suggests that facial masks may damage the skin. We present a series of six patients with ear-looped face mask associated retro-auricular abscesses (RAAs) from a tertiary referral centre, observed between March 2020 and May 2021. Patients' past medical history included recurrent skin abscess (n=2), seborrhoeic dermatitis (n=1) and pre-existing postauricular cyst (n=4). All patients reported prolonged use of ear-looped face masks. Incision and drainage of the abscesses were carried out in all cases, followed by systemic antibiotic treatment. All patients recovered without complications and no recurrences (follow-up 11-17 months). We hypothesise that ear-looped face masks may promote the formation of RAAs. Possible mechanisms include local mechanical pressure, friction, changes in the skin's temperature, humidity and microbia, inducing local inflammation and infection, leading to retro-auricular sebaceous duct obstruction.