Infectious Diseases | Mount Sinai Today

My Face Covering Is Causing Acne. What Can I Do?

Updated on Jun 30, 2022 | COVID-19, Skin Health, Your Health

Wearing a face covering has become a necessary way of life as we continue to combat COVID-19. Unfortunately, this risk reducing measure can result in ‘maskne’—acne, breakouts, and skin irritation caused by prolonged wearing of a face covering.

Andrew F. Alexis, MD, MPH, Professor and Chair, Department of Dermatology; Mount Sinai West and Mount Sinai Morningside; and Director of the Skin of Color Center at Mount Sinai, explains what you can do to prevent breakouts while staying safe.

I think my face mask is irritating my skin. What can I do to prevent this?

Wearing a mask can inflame or irritate the skin in a number of ways. First, the pressure and friction on the bridge of the nose and behind the ears can lead to redness, soreness, bruising, and even erosions—erosions are particularly prevalent when N95 masks are worn for long hours.

Strategies for prevention include hydrating the skin and protecting the skin barrier with a gentle cleanser. After cleansing, use a non-comedogenic moisturizing lotion—a moisturizer formulated to not block pores—that contains hydrating and skin-protective ingredients such as ceramides, hyaluronic acid, glycerin, and dimethicone.

Ceramides are natural lipids that help support the skin’s barrier while hyaluronic acid attracts water and therefore, helps to hydrate the skin . Another moisturizing agent—glycerin—attracts moisture into the skin and dimethicone helps to seal the moisture by preventing it from evaporating from the skin surface.

Is there a material that is better for skin and more ‘moisture wicking’ that should be worn in warmer weather?

Fabric-based face coverings made of 100 percent cotton are breathable and recommended for the summer. They should be washed daily to prevent the build-up of oil and bacteria that can contribute to acne and related skin conditions. It is also important to wash the face twice daily—morning and evening—with a gentle cleanser. Unlike traditional soaps, gentle cleansers have mild surfactants (they are synthetic detergents or “syndets”) and have hydrating ingredients like glycerin.

I have to wear a face covering for hours each day. What else can I do to relieve irritation?

For health care, essential workers, and others who may wear N95s for long hours, placing a thin prophylactic silicone foam dressing to the bridge of the nose and behind the ears is a helpful tip—but one must ensure the seal of the mask is not compromised. If irritation does occur, applying a thin layer of healing ointment—like petroleum jelly—to the affected areas can help.

Also, when possible and in a safe/socially distanced environment, periodically removing the mask can provide extra relief and reduce the risk of heat rash or irritation from prolonged mask wearing.

Do you have any other advice about keeping skin healthy while wearing a face mask?

To avoid breakouts, I recommend doing without makeup – at least under the mask.

Additionally, ‘maskne’ sufferers may want to try using a benzoyl peroxide gel (5.5 percent or less). This is a useful non-prescription treatment for mild acne.

If the above advice does not clear up your breakouts or your acne worsens, make an appointment with a Mount Sinai dermatologist for an in-office or virtual visit.

Schedule an appointment with a dermatologist at Mount Sinai

Sickle Cell Patients Advised to Seek Care in Time of COVID-19

Updated on Jun 30, 2022 | COVID-19, Featured, Sickle Cell Disease, Your Health

File photo: Jeffrey Glassberg, MD

At the start of the COVID-19 pandemic, physicians who specialize in sickle cell disease feared that their vulnerable patients would be especially hard hit. Indeed, COVID-19 is still a serious public health threat, but the experience of patients with sickle cell disease has been surprising in many ways, according to Jeffrey Glassberg, MD, Director of the Comprehensive Program for Sickle Cell Disease at the Icahn School of Medicine at Mount Sinai. Here is what Dr. Glassberg says people should know about COVID-19—and about advances in sickle cell treatment that have made this a time of “tremendous optimism.”

What have you learned about the COVID-19 risk for people with sickle cell disease?

When COVID-19 initially became a problem for us in North America, we were very worried. This is especially true because people with sickle cell disease get something called acute chest syndrome, which is a situation where the lungs fill up with fluid and it becomes harder to breathe. Since COVID-19 is a disease where you get basically a viral pneumonia, I was very scared about what was going to happen to all the people that I take care of.

As it turned out, it was not nearly as bad as I had feared. Our patients actually wound up doing quite well. One after another was treated for a day or so, and released. So we were very relieved. And we pooled our data with other centers and found that only sickle cell patients with other serious risk factors, like major heart disease or kidney failure, did poorly with COVID-19. As the Centers for Disease Control and Prevention points out, COVID-19 is a new disease, and there is still only limited data and information about its impact and risks. But here on the ground, in clinics, this is what we have seen in recent months.

Is there an explanation for these outcomes?

We aren’t sure yet. But one thing we know about COVID-19 is that the older you are, the worse it is. And in general, our patients tend to be a little bit younger, partially because, sadly, the average lifespan for someone with sickle cell disease is probably around 50 years old. So we have a lot of young patients.

What do you advise your sickle cell patients to do now?

COVID-19 is still an infection that you don’t want to get. However, if you have sickle cell disease, there are real dangers to not getting your medical care, and so you shouldn’t put a stop to all visits to the hospital.

People with sickle cell disease need a lot of medical care. They need to be watched closely; they need to have their labs checked very often, on very specialized medicines. If our patients with sickle cell disease are unfortunate enough to get coronavirus, it seems as if they don’t have any additional risk, or at least not much more risk than a normal young person experiences. But the risk of not getting your medicine or not getting your labs checked—that’s big. You could be on the wrong dose of medicine. So especially now that the pandemic is cooling off, and we have low rates of coronavirus in the New York region, this is a great time to come and get your medical care and catch up on things that didn’t get taken care of during the height of the pandemic.

How prevalent is sickle cell disease, and what does it do to the body?

Sickle cell disease occurs in about 100,000 Americans and about three million people worldwide. It affects people who are descended from areas of the world that have had malaria—so that can be Africa, South America, or the Middle East. It is a disorder of the blood caused by a genetic mutation. And it causes effects in every part of the body, because blood supplies every part of the body, but the most common manifestation that we see is pain. Patients will have episodes where suddenly they feel terrible pain. That is described as worse than delivering a baby, worse than having your bones broken, and you very often need to come to the hospital to be treated.

What are some of the recent big advances in sickle cell treatment?

Sickle cell disease today is in a place where we have tremendous optimism. I remember back in 2010—the 100th anniversary of the discovery of the gene that causes sickle cell—we were lamenting the fact that we had only one medicine to treat this disease, hydroxyurea. Fast forward 10 years, and we have 40 medicines that are in development, and four really good medicines that are FDA-approved. In addition to hydroxyurea, we now have L-glutamine oral powder and crizanlizumab, which reduce the number of painful crises, and voxelotor, which improves anemia in people with sickle cell disease. And then we have gene therapy, which cures sickle cell disease. Gene therapy at this point should not be the option for everybody because you do need to get chemotherapy to get gene therapy. But we are really at the cusp, I feel, of curing the disease.

And while we wait for this cure, we have new medicines that enable us to control the disease to a level we never have before. So this is an incredible time for the community of people with sickle cell disease. If you don’t already have a sickle cell specialist, come and see somebody who is really plugged into all of this to make sure that you are availing yourself of all these new therapies.

Any final advice for people with sickle cell during the pandemic?

Anybody can have a bad outcome with this COVID-19, even a perfectly healthy 25-year-old person. And you can spread this virus even if you feel well. So we should all be very cautious. We should continue to wear masks; we should continue to wash our hands; and we should avoid unnecessary travel and unnecessary trips to crowded places.

We have been fortunate enough through this pandemic to learn a lot about telemedicine. And so we have expanded those options, where you can see a sickle cell specialist through telemedicine wherever you are in the tristate area, and get many of your needs taken care of. When it gets to the point where you need treatment in person or lab tests, it now makes sense to come in, because hospitals have done an excellent job making it safe.

Mount Sinai Research Shows That Children Have Lower Risk of Catching COVID-19

Updated on Jun 30, 2022 | COVID-19, Featured, Research

Supinda Bunyavanich, MD, MPH, and post-doctoral fellow Scott Tyler, PhD. File photo.

On Saturday, March, 14, as the U.S. economy was beginning to shut down due to the COVID-19 pandemic, Supinda Bunyavanich, MD, MPH, a mother of two young children and a Professor of Genetics and Genomic Sciences, and Pediatrics, at the Icahn School of Medicine at Mount Sinai, had a “eureka” moment.

“I was at home thinking about the world and how New York City was being hit, and I realized so much is unknown about this virus,” Dr. Bunyavanich recalls. As a parent, Dr. Bunyavanich says she was relieved to read that children appeared to be less susceptible to catching COVID-19 than the rest of the population based on reports from China, although no one knew precisely why.

Dr. Bunyavanich was on the phone that day with Alfin Vicencio, MD, Chief of Pediatric Pulmonology at the Icahn School of Medicine at Mount Sinai. They discussed how the SARS-CoV-2 virus, which causes COVID-19, might enter the body through ACE2 receptors—proteins on the surface of many cells, including those found in the lining of the nose. At that moment, she realized she had important data that connected both lines of research.

“I thought, ‘wait a minute,’ ” Dr. Bunyavanich says. “COVID-19 is a respiratory condition. I have data on what’s happening in the noses of people of many ages from my studies of asthma. Could it be that kids have fewer access points for the virus to enter?’”

In May, JAMA published the novel findings from Dr. Bunyavanich’s data, which showed that lower ACE2 expression in children relative to adults may help explain why the disease is less prevalent in young children.

“The degree to which we express ACE2 may play into how susceptible we are to the SARS-CoV-2 virus,” Dr. Bunyavanich says. “Our finding that there are age-related differences in the level of ACE2 is consistent with epidemiologic data from around the world that children suffer less from COVID-19. Lower nasal expression of ACE2 in children is a concrete finding from our study that might explain why children are less affected by SARS-CoV-2.”

Interestingly, Dr. Bunyavanich’s data are from a Mount Sinai study she has been leading for a few years that looks for nasal biomarkers for asthma. The data, part of a study of 305 individuals between the ages of 4 and 60, includes “an atlas of genes that a person expresses in their nose,” she says. “The original project wasn’t targeted to ACE2, but we had this library of information on hand, so we homed in on ACE2 given its potential role in COVID-19.”

The researchers found that young children have the least expression of ACE2 in their nasal passages and that the quantity increases with age, so that children 10 to 17 years of age have more than younger children, but less than young adults age 18 to 24. The highest level was found in individuals 25 and older.

It is possible, she says, that young children have plenty of virus particles in their noses, but perhaps they are less likely to enter the body. “Think of ACE2 as a doorknob that SARS-CoV-2 uses to get in. There might be plenty of virus waiting to get through the door, but it has a harder time compared to adults,” she says. “The virus won’t cause illness if it can’t get in.”

According to Diana W. Bianchi, MD, Director of the National Institute of Child Health and Human Development, young children tend to be mildly affected by COVID-19, and relatively few end up in intensive care units. Their symptoms also present differently than those in adults, with diarrhea, abdominal pain, and other gastrointestinal problems.

Many questions surrounding children and COVID-19 continue to be the focus of widespread debate, particularly as communities consider whether to reopen schools in the fall.

“In-person learning versus virtual learning is such a complicated topic,” says Dr. Bunyavanich. “For every family it’s going to require a different set of considerations about risk versus benefits and what their preferences are. Even though children are less susceptible overall, susceptibility might vary between individual children, and it’s still possible for children to carry the virus. You have to think of the whole web of complex interactions children have. That’s what makes it so hard.”

Most People Mount a Strong Antibody Response to COVID-19

Updated on Jun 30, 2022 | COVID-19, Featured, Research

Daniel Stadlbauer, PhD, a postdoctoral fellow in Florian Krammer’s laboratory, adds a substrate to an ELISA plate that indicates whether antibodies binding to the spike protein of the SARS-CoV-2 virus are present in a human serum sample. The deep yellow color indicates antibodies are present. No color means that antibodies are not present.

The majority of individuals with COVID-19—including those with mild infections—mount a robust antibody response that is stable for at least three months, according to a new study by researchers at the Icahn School of Medicine at Mount Sinai. This antibody response correlates with the body’s ability to neutralize or actually kill the SARS-CoV-2 virus.

Mount Sinai’s findings concur with studies conducted by major academic institutions elsewhere. Scientists have now had more than three months to track the levels of antibodies produced by individuals since the SARS-Co-V2 virus began to infect populations around the world.

“There were messages about the antibodies going away quickly. That’s not the case,” says Florian Krammer, PhD, Professor of Microbiology, Icahn School of Medicine at Mount Sinai, a senior author on the recent preprint study. “The take-home message is that it looks like a pretty normal immune response.” Dr. Krammer developed one of the first effective SARS-CoV-2 antibody tests, which received emergency use authorization from the U.S. Food and Drug Administration at Mount Sinai’s clinical laboratory.

Additional time will be needed to determine how protective those antibodies are and how long-lived they are beyond three months. So far, Dr. Krammer says, animal models show that antibodies to COVID-19 behave like typical antibody responses to other diseases, meaning they protect from reinfection. The same scenario is likely for the vast majority of individuals, he says. If people become infected again their symptoms would likely be less severe.

“You need to follow people to see how long the antibodies are stable. These studies require time and there will be more data as researchers look at antibodies after 3 months, after 6 months and then again after a year,” Dr. Krammer says. He and his colleague, Viviana Simon, MD, PhD, Professor of Microbiology, and Medicine (Infectious Diseases), at the Icahn School of Medicine at Mount Sinai, are doing exactly that. In a study called Protection Associated with Rapid Immunity to SARS-CoV-2 (PARIS), they are tracking the antibody levels of, approximately, 140 individuals over 12 months. “We examine the participants every two weeks so we get a very granular look at how the antibodies are moving,” Dr. Krammer says.

Within the human body there are several levels of defense. In a typical response, acute plasmablast B cells are generated within days of an infection. These first responders serve as the infantry and coalesce to make an initial bolus of antibody, but their strength soon wanes. Then the body’s immune system kicks in with long-lived plasma B cells, which provide antibodies over a long period of time, and memory B cells, which can respond quickly if the virus attacks again. COVID-19’s relatively long incubation period of upwards of 7 days, likely gives the body ample time to create antibodies quickly if a reinfection would occur.

In addition to these B cell antibodies, the human body makes memory T cells, which appear to be helpful in fighting off the SARS-CoV-2 virus. In fact, blood samples taken from individuals who survived the first SARS virus in 2002-2003—a coronavirus cousin of SARS-CoV-2—showed they still had active memory T cells 17 years later, according to the National Institutes of Health (NIH). Interestingly, the NIH reported that these memory T cells now also recognized part of the SARS-CoV-2 virus.

“There’s a lot of evidence that we see a normal immune response,” Dr. Krammer says. “Now that doesn’t mean we will all be protected forever. And it doesn’t mean that it’s impossible to get re-infected, specifically if someone is immune suppressed. We just don’t have that data yet. We will generate that data as we move forward.”

What You Need To Know About Taking A Vacation this Summer

Updated on Jun 30, 2022 | COVID-19, Your Health

After months of staying close to home and maintaining social distance, many in the New York metropolitan area are ready for a change of scenery. However, with COVID-19 still prevalent throughout the United States and border restrictions limiting international travel, is leisure travel safe?

Daniel Caplivski, MD, Director of the Travel Medicine Program at Mount Sinai, and Professor of Medicine (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai, explains what you need to know about getting out of town as the nation continues to battle COVID-19.

Would you recommend leisure travel this summer?

I do think it’s possible to safely travel within the United States, but there are caveats.

It is important to assess the risk of COVID-19 for each traveler. The CDC has a nice set of recommendations to help you figure out who is the highest risk for having a very severe reaction to COVID-19. This list includes those who are diabetic or obese and older people—particularly those above age 60 or 70.

That is the first thing a traveler should consider—what is my risk of a severe outcome. Younger people can get very sick from COVID-19, obviously, but it’s a different set of considerations for older people and those with underlying medical conditions.

And then, what is the risk of acquiring the virus when visiting a particular area? The CDC also has outlines to help people think through this process. In the early spring, New York City had the most cases and the highest level of transmission. But now, the focus of the epidemic has shifted towards the south with states like Texas and Florida reporting a high number of cases.

So, those considering vacations this summer should look at the guidelines from the CDC to assess their risk and the risk of transmission within their destination.

If you will be travelling, what is the safest mode of transportation?

The CDC does a nice job of assessing each one of those modes of travel for risk and there’s some commonalities to all of them—any scenario where you are going to be in close contact with a lot of other people will increase your risk of contracting COVID-19. Whether in an airport or a train station, if you are in a location where it’s hard to socially distance, you will increase your risk.

In terms of mitigating that risk, wear a face covering throughout your trip—as appropriate—and have hand sanitizer with you at all times. Airlines are now allowing, travelers to carry larger bottles of hand sanitizer in their carry-on, which is helpful.

How high is the risk of contracting the virus from other passengers?

The risk from fellow passengers is probably highest from those who are within about two feet—so, within one row in either direction. That’s fairly small in terms of the overall number of people on the plane. Also, the air in planes is constantly being circulated with the outside air and filtered using high efficiency particulate air (HEPA) filters. That adds to some risk reduction. But you should still wear face coverings and use hand sanitizers, especially after engaging with high-touch surfaces like restroom handles.

If you are travelling by train, you can be a lot more spaced out. So, if you can find a seat that’s more distant from other people, that would mitigate your risk, along with wearing a face covering and using hand sanitizer. It’s also worth noting that Amtrak trains have an air filtration system as well.

Given that air and train travel—even when using proper precautions—involves encountering unknown people who may have the virus, is travelling via car or RV with family or friends the safest?

Since you are traveling with people that you know, that’s generally a safer scenario. But, usually you have to stop for gas, snacks, or even the restroom. So, hand hygiene remains important especially after using public facilities.

Once you reach your destination, are there activities that you should avoid?

Travelers should apply the same principle when traveling as they do in the New York metropolitan area. People have gotten used to the concept of wearing some sort of face covering, practicing social distancing, and avoiding scenarios where it’s very difficult or impossible to socially distance, especially when indoors. We know that the transmission of the virus in indoor facilities is much more efficient than in outdoor scenarios. So, whenever possible, try to look for outdoor activities as opposed to indoor ones.

Beaches are an example where, generally, it is possible to socially distance from people and reduce your risk of contracting the virus. Swimming pools can also be a safe place to go if you’re able to maintain social distancing as the chlorine in the water is considered to inactivate the virus. With these locations, travelers should be hyper vigilant in bathrooms, locker rooms, and changing areas where it may be more crowded and there are more high-touch surfaces.

Should you self-isolate after your vacation?

This depends on where you’re coming back from right. New York State has some guidelines for travelers returning from states where there’s a lot more COVID-19 cases.

There are going to be recommendations at the state level for self-isolation or self-quarantine for asymptomatic returning travelers. Travelers should keep an eye on state recommendations as well as the CDC map of where there are high levels of COVID-19 activity.

If you are going someplace that doesn’t have a high level of COVID-19 cases but you have contact with someone who is at high risk of a severe case of the virus, should you take extra precautions on your return?

The Mount Sinai Health System has some guidelines for our health care workers because we come in contact with people who are immunosuppressed and have a high risk for severe COVID-19. The common sense approach for travelers is what a lot of health care facilities like Mount Sinai are doing, which is requiring that people conduct a self-symptom check.

If you are returning from a relatively low risk area, do a self-assessment. You can return to being in contact with older loved ones, as long as you do not have a high fever, a cough, shortness of breath, loss of smell, or any of the typical symptoms for COVID-19.

Are there any additional behaviors that the public should be aware of when traveling during this time?

Lodging is a big consideration. My Mount Sinai colleague, Mirna Mohanraj, MD, addresses the safety considerations travelers should make when visiting a hotel or vacation rental in this blog.

Additionally, the CDC recommends bringing sanitizing wipes when you travel for high touch surfaces, like doorknobs and bathroom fixtures. The CDC also recommend basic things that have become second nature to many within the New York metropolitan area like no contact service and avoiding buffets, group gatherings, and gymnasiums.

How to Safely Visit the Pool and Spa This Summer

Updated on Jun 30, 2022 | COVID-19, Your Health

As the New York metropolitan area continues to keep the COVID-19 curve flat, more establishments have opened. But, before hitting the pool or booking an appointment at the day spa, be aware that the risk of contracting the virus has not dissipated.

“Any place where we have public interaction beyond our immediate family or immediate contacts, we are exposing ourselves to the virus,” says Waleed Javaid, MD, Associate Professor of Medicine (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai. “The more people we meet, the more interactions we have, the expansion of our social circle; this increases our risk.”

Dr. Javaid explains what questions you should ask before visiting your local pool or spa to ensure the safest possible visit.

What precautions should you take before heading to the pool?

I think it will be important to make sure that the pool or hot tub that you are entering is following up on disinfection protocols. The cleaners and disinfectants used in and around the area should be registered by the US Environmental Protection Agency to kill the virus.

Do saunas and steam rooms pose a risk of spreading COVID-19?

If you’re not following social distancing guidelines, there is a risk. But it really depends on the size of the facility and how they may be modifying their business practices due to the virus.

Masking is not going to be effective in a sauna or steam room because—besides being incredibly uncomfortable—the moisture will likely reduce the efficacy of a face covering. So perhaps it is best to do individual saunas.

Not every place is going to do the same thing, so people should be proactive in asking about what kind of protections are in place for safety before entering an establishment.

Since there is no standard protocol for these establishments, what should people ask before visiting?

Before visiting a pool or spa, people should ask two questions: What is the facility doing to prevent the spread of COVID-19 and what is the process they are using to ensure the virus does not spread throughout their establishment.

From there, you can go into some specifics.

What disinfectant is in use?
What is the social distancing process and how is it being reinforced?
How many people are allowed in the facility at any given time?
How often are shared spaces being disinfected?
Is shared equipment being cleaned between each customer?

Additionally, I would recommend that people review guidance from the Centers of Disease Control and Prevention on public pools, hot tubs, and water playgrounds.

Despite spas being allowed to open, at this time gyms throughout the New York metropolitan area remain closed. Why are gyms particularly risky? Is the virus spread through sweat?

At this time, we do not believe that the virus is spread through sweat. However, the risk with gyms is related to the amount of people in an enclosed area. I continue to recommend that everyone stay safe by keeping their distance. So, individualized outdoor exercise like walking, jogging, running, or even outdoor yoga is better than exercising indoors.

Gyms have many people exercising indoors—whether on machines or in fitness classes—and sharing equipment. Contrast that with a spa where the activity—like a facial or a massage—though indoors, is individualized. So spas—where the interaction is often between one or two individuals—present a more controlled environment.

At least, that is how I think this decision is being evaluated.

Do you have any other advice about how to stay safe as we continue this reopening effort and begin to expand our social circles?

Everybody needs to take charge to protect their health and the health of those around them. If, for example, you feel unsafe in a grocery store because there’s too many people, don’t be afraid to remove yourself from that situation.

Also, just because more places are open doesn’t mean that you have to enter them, especially if strict social distancing is not being practiced.

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