Impact of Prolonged Use of Face Masks on Nasal and Skin Microbiota among Healthcare Workers and Related Populations: A Systematic Review and Exploratory Meta-Analysis

BackgroundProlonged face mask use is an essential occupational safety measure for healthcare workers (HCWs), especially during the COVID-19 pandemic. While mask wearing effectively reduces exposure to respiratory pathogens, extended use creates a warm, humid, and occlusive microclimate that may disrupt the nasal and facial skin microbiota, potentially affecting comfort, barrier function, and occupational well-being. This systematic review aimed to synthesize primary research evidence on the impact of prolonged face mask use on the nasal and facial skin microbiota among HCWs and related population.MethodsA systematic review with an exploratory meta-analysis was conducted following the PRISMA 2020 statement. Searches were performed in PubMed, Scopus, and Web of Science for studies published between January 2000 and December 2025. Inclusion criteria were observational and interventional studies involving HCWs or related populations exposed to at least four hours of mask use per day, with nasal or facial skin microbiota as an outcome. Due to heterogeneity in study methods, findings were narratively synthesized.ResultsA total of eleven primary studies met the inclusion criteria: four examined nasal microbiota, and eight examined facial skin microbiota. Consistent evidence indicated that prolonged mask use (4 to 12 hours per day) was associated with reduced microbial diversity. Nasal microbiota analyses revealed increased relative abundance of Staphylococcus and Corynebacterium species and decreased commensal species. On facial skin, reduced microbial diversity and dominance of Cutibacterium species were observed, particularly among individuals with mask-related dermatological symptoms. An exploratory meta-analysis of four studies showed no significant decrease in microbial diversity, with high heterogeneity (I 2>70%).ConclusionThis synthesis of eleven studies indicates that prolonged mask wearing is associated with localized alterations in the microbiota, primarily affecting facial skin and nasal microbial communities. These changes likely represent ecological adaptations to humidity and occlusion rather than clinically harmful dysbiosis.