Help with Cheek Irritations

Don't know what happened, Mike was doing so well, but he has now developed pretty bad redness on both cheeks, more on his left where he sleeps. I'm thinking the straps have been too tight. At 5PM when it was still quite red, I called the Dermatologist but he was gone, so I called the RT, who only advised that he NOT wear his mask tonight and try the ComfortGelFF tomorrow instead of the UMFF. He does have very sensitive skin. I also called the Pharmacist who also said not to wear it tonight. He said to apply Aquaphor lightly tonight to help heal it. I know some of you have had these problems so I'm asking for help on what to do. I'd hate for him to not wear his mask tonight. Can I apply a light coat of Aquaphor on his skin before putting on the mask or will it not seal? Hoping for good advice. Dori

Hi Dori,

Here are some suggestions given to cpapper a few posts below: viewtopic/t36158/Need-help-with-skin-issue.html
CereVe i believe has been used successfully by others.

Is the irritation where the mask touches the face, or where the straps touch the face? If it's the latter, then go for pad-a-cheeks http://www.padacheek.com/ - she's a forum member and makes these wonderful fleece headgear covers!

Edit: make sure he uses his machine tonight! Since xPAP seems to be pretty critical for him, I would stay on the safe side and make sure he doesn't stop using it, even for one night! (I'm no doctor, just my opinion...)

Echo, it's on both cheeks, more on the left side where he sleeps, quite red. The straps aren't leaving any marks. I will look into CereVe tomorrow. Do you know anything about Lansinoh? I think I've read about it here.

Hi dori, sorry the extent of my knowledge ends there. I haven't really had any issues with that and haven't really kept track of the posts on this topic... I did a quick search on Lansinoh and there is some info on there.. just go to the search box at the top and search on it. Sorry I can't be of more help, but I am sure others will chime in. Good luck!

I have trouble with redness on my cheeks and chin; the checks from the straps, and the chin from the bottom part of my mask. I found that mask strap pads, although very helpful with strap marks, can sometimes be too hot for me, and have made my redness worse at times. But that might not be the case with everyone. My redness usually gets better during the day, but never completely goes away. It's not sore. I'm thinking mine might be rosacea.

One thing I tried is putting a layer of tissues or other thin material between the straps and my face. Even tried it on my chin with the mask. It helped my redness some on both my checks and chin, and the mask even stayed sealed in the chin area when I used there. Don't know whether this will help or not, but thought I'd mention it.

I think I'll try the CereVe, too!


Pam

Dori,

I use Lansinoh. It is a lanolin product that has a tacky feel to it. I put a tiny amount around the rims of my nostrils to help seal my nasal pillows mask, and it works great for that. Its intended purpose is for nursing moms to apply to their nipples to counteract dry skin. So, while I don't know if it has any healing properties, it certainly has moisturizing properties. It have never used it other than as a aid to sealing.

If I were your husband, I probably would apply a triple antibiotic cream, but since I am not a health care professional, I don't know whether or not that would help him. I am unfamiliar with CereVe or Aquaphor, so can't comment on those.

Good luck.

Dori,
Maybe I can help.

When you press on the redness-does it go away? This is called blanching in the medical field. It is a good sign if it goes away and comes back in less than 3 seconds. Do this to your arm and you will see what I mean. Your skin will be more pale when you press on it. If it does not that means that he has a pressure sore to that area. {I developed one on my forehead once.} You have a few treatment options.

• Moisturize during the day and gently massage the area several times a day.
  
  Loosen the straps as much as possible.
  
  Turn to the least affected side. I believe if both sides are red you may need to help him prop a little towards his back/side with pillows. I know that generally speaking OSA is not good on backs but 45 degrees would be better than mushing his face into the pillow. Look into changing the pillow so it pushes on the mask less. If I understand the situation correctly, your dh has had a stroke in the past? If that is so, he needs to not be sleeping in the same position all of the time anyway. I know this is hard when there are preferred sleeping positions. But it will help his overall lung function and long term skin health.
  
  You can also get some of these type dressings to put on his cheeks http://www.walgreens.com/store/product. ... prod392263 these will provide a good healing area for him and they can stay on several days. The medical term used for these is "duoderm". They are handy to have on hand with mobility restricted patients. You would need a prescription for larger ones than these. I used this to heal my forhead.

Some of these same treatments will help if this is a rash or a pressure ulcer. Of course making sure the mask is cleaned daily will help too.
You have my respect and admiration. I know some of what you are going through since my background is RN with acute, home health and long term care experience. Let me know if I can be of any further help.

Lansinoh is great for cracked skin. It is lanolin and has great healing properties. BUT, it is stiff to get on you really have to warm it in your hands. It creates a barrier to liquids so works great for fanny rashes as well as for nursing moms. I would imagine that it would be hard to clean off of a mask. Some people find the scent of lanolin pleasant and some not so much. It is reminiscent of A and D ointment. Which has Lanolin in small quantities, Vit D and petrolium. If I had to choose I would choose the straight lanolin. A little dab 'ill do ya!

Thanks for your knowledge. I did the press test and it did not turn white, so it's definitely an irritation on his cheeks, especially the left side where he sleeps. Mike did not have a stroke, but he is a "senior" fellow and is just starting to understand and participate in his cpap therapy, but pretty much leaves it up to me. I adjust his straps because he can't get used to the velcro so I probably made them too tight, it's hard to tell without much input. He sleeps on a foam pillow that I have carved out on both sides but will curve it a little more tomorrow. BTW, the Derm did return my phone message a while ago and told me to use the prescription cream he had prescribed for another rash Mike had a few months ago. He recommended he not use the mask tonight as he knows how sensitive his skin is. Told me to have him use 2 pillows tonight. He's also allergic to Bandaids, we use paper tape for bandaging. I wonder if just slipping a thin tissue between his cheeks and the mask would bother the seal? I'll figure out something with a little help from my friends here.

The link I posted was not a "bandaid" other than in brand name. It is a special dressing that relieves pressure and promotes healing. It is just now becoming over the counter for severe scrapes, etc. I would go with what your dermatologist said since they called you back. If you talk to him again ask him if he thinks a duoderm type dressing would help. They can be very thin and trimmed to fit the area especially if you get 4x4's. They are self adhesive and hypoallergenic. However you do need to leave them on two or more days in a row unless it falls off on its own.

I don't know where I got the impression he had had a stroke. Please forgive me.

Good Luck,
Tricia

Hi Dori, a couple of more non-medical suggestions from me-
For the pillow, I don't know if you can get him to sleep on the edge of it? I mean instead of carving a hole for his mask, just have his head rest on the pillow with the mask hanging off. I don't know if that will work though, since we move around at night, and anyway his cheek will still have pressure on it.

Second option, maybe you can go for a Liberty or a Hybrid mask. That will still make contact with his skin around his mouth, but not the entire cheek. Maybe that will help.

Dori - You got some really good help here, as usual, even some medical help! That's great. I know about duoderm since I use it on my heel sometimes. Eight years ago I had a very bad pressure sore on my heel. I had to have a visiting nurse come in daily and debride it and change the dressing. Being a senior, it is still very vulnerable so I put duoderm on the heel if it gets sensitive. I know there is duoderm type dressing bandaid that promotes healing.

Don't know how it would be on the face,as pudellvr said, or what it might do to a mask seal, especially since Mike uses a full face mask. It's worth checking out.

If Mike went without his mask last night and was propped up with an extra pillow he may be more fatigued today. That's normal (like pre cpap days!). If he has to go without it for several days to heal this, he will experience even more fatigue.

You mentioned that the RT suggested the other mask tonight. It may hit the cheeks in different spots. If so, it should work.

Anyway, you have lots of great advice! What a great forum!

You may well be making the straps too tight. Most masks work better when the straps are looser (not falling off but not tight either) - it's hard to achieve!

Let us know how things go. Good luck!

Tricia, thanks for the suggestion re Hybrid/Liberty. I will check that out. As for the duoderm, he had an infection on this buttock from shrapnel wound during war, had surgery down to the bone, wound nurses for 6months, then taught me to do it. They tried duoderm but he was allergic to the adhesive(any adhesive), gauze and paper tape was all we could use. Hoping this is just temporary because of poor strap adjustment or the way he slept.

Hawthorne, you're right, although I was surprised he slept pretty quietly last night at least the times I was awake, he is pretty tired today like the old days, still napping away right after breakfast.

UPDATE! The Dr. just called back(he's wonderful, as are all our Drs.) He wants to see Mike at 1:30 today and wants us to bring his masks so he can help figure out what to prescribe. Will let you guys know later. What a bummer!!

Update on Dr. Visit. Cheeks were still inflamed but skin was not infected. He prescribed a steroid cream and said it should be better in another day or two. He wants him to go without the mask for one more night. Surprisingly, he says he slept pretty good last night, and I observed that his breathing was much quieter than before cpap. He said he didn't feel as though he woke up during the night except to go to the bathroom twice as usual. It seems from what I saw while I was awake that he's trained himself to sleep with his mouth closed. He was feeling OK today. Now here's the big Finale! A few weeks ago I ordered the CPAP Mask Wipes from cpap.com without checking in with you guys first for opinions. I was thinking that besides just washing the mask with mild soap and water, the wipes would do an EXTRA good job(more is better!) and what could be better than something made especially for masks? I brought the container with with me and the Dr read the ingredients and didn't like this product at all, and thought Mike may have built up an allergy to it. He absolutely insisted that I use nothing but plain Ivory soap and rinse well with warm water, something that his skin is already used to as that is what he uses for his daily showers. So that's my confession, sorry I didn't mention the wipes when I was seeking your advice. I also have to make sure the straps are not too tight. BTW, Dr also was not too keen on the Mack's for Mike's type of skin, hard to know what will set off an allergic reaction. Do you think that putting a thin piece of tissue between the cheek area and mask would break the seal? I think I read that somewhere here. Thanks to all of you for your support. Dori

Padacheek made me a 'gasket' for my UMFF that works wonderfully. It keeps the mask from touching my skin and only raises my leak rate by a couple of points(not an issue for me). I get no marks at all from the mask anymore! Might be worth it for you to get ahold of Karen and see if she can make you one. Maybe pad-a-cheeks to match?

Brenda

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