PPE-Associated Skin Lesions Among ICU Healthcare Workers: Clinical Characteristics and Anatomical Distribution

Background: Personal protective equipment (PPE) is essential in intensive care units, especially when caring for patients with severe respiratory infections. At the same time, prolonged use of respirators, gloves, gowns, and face shields, together with frequent hand hygiene, can irritate the skin and weaken the skin barrier. These reactions may affect comfort during long shifts and make continued PPE use more difficult. Objective: This study evaluated the prevalence, clinical characteristics, morphology, symptoms, and anatomical distribution of PPE-associated skin lesions among ICU healthcare workers. Methods: This cross-sectional observational study included physicians and nurses working in respiratory infection ICUs of governmental hospitals affiliated with Isfahan University of Medical Sciences, Iran. Demographic and occupational data were collected using a structured questionnaire. All participants were examined by board-certified dermatologists, and lesion type, morphology, symptoms, and anatomical distribution were recorded. Results: Among 68 ICU healthcare workers, 61 participants (89.7%; 95% CI, 80.0–95.8) had at least one PPE-associated skin lesion. Clinically diagnosed contact dermatitis was the most frequent diagnosis (77.9%), followed by acne (10.3%) and eczema (7.4%). Erythema was the most frequent morphological finding (70.6%), pruritus was the most frequently reported symptom (88.2%), and the hands were the most commonly affected anatomical site (83.8%). Conclusion: PPE-associated skin lesions were common in this regional ICU cohort. Clinically diagnosed contact dermatitis, pruritus, erythema, and hand involvement were the predominant findings. Because the cross-sectional design does not establish causality, these findings should be interpreted as clinically probable occupational associations and require confirmation in larger longitudinal studies.