“Maskne”: It’s Not Just for Teens

Just over a month ago, the Centers for Disease Control (CDC) recommended everyone wear a mask while in public to prevent the spread of covid-19.  These masks and face coverings provide a layer of protection; however, we are also observing a direct relationship with irritated the skin, clogged pores, and acne flares – even in patients who have never experienced acne in the past. P. acnes is not the only culprit when it comes to the cause of acne blemishes.  Many patients traditionally present with “pimples” assuming they’re hormonal or from oil or bacteria on the skin; when in fact, there are many other factors which Dermatologists consider.  “Maskne”, or acne in the distribution of the area where the mask makes contact with or covers the skin, illuminates some of these classic causes in a present day, situational light. There are three main factors related to mask wearing that cause breakouts: Irritation:  Acne is often a cycle of inflammation and irritation.  Whether the source of inflammation is picking, squeezing, hormones, poor exfoliation, over exfoliation, occlusion, oil, or bacteria, inflammatory factors fuel and flare breakouts.  This is why it’s no surprise that when material of masks don’t agree with a patient’s skin, or certain detergents and dyes used on the fabric are exposed to sensitive facial skin, we see redness, dry patches, peeling, or even skin discoloration.  Patients with pre-existing rosacea, eczema, or skin allergies are even more likely to flare easily from exposure to these residues. Occlusion:  While the mask, itself, is a skin covering, it also traps your breath beneath the material, making the surface of your skin moist and humidified.  It can change the pH of your skin, altering the environment and making it host to additional bacteria and yeast colonization inside the hair follicles of the face.  This leads to a condition called folliculitis which is similar to acne, presenting with redness, pimples, and pustules.  Pores can also become clogged when makeup or surface oils are further humidified, leading to pimples or acne cysts. Rubbing & Pressure:  Masks make the most contact with the bridge of the nose and the area behind the ears where the elastic touches to pull the mask taught.  This can cause irritation through chafing, rubbing, and pressure, sometimes even leading to skin breakdown and degradation.  This is similar to a condition called “acne mechanica” which presents in patients who are chronic pickers.  They may not even have active acne; however, the desire to pick and squeeze creates constant pressure and inflammation, sending inflammatory factors to the area, and creating a focused problem where there previously was none. The good news is, you can take measures to protect your face from irritation while you take measures to protect yourself and your family from novel coronavirus. Remember to: 1) Always start with a clean face.  Use a gentle cleanser that is fragrance free and oil free to prevent irritation and clogged pores.  Reading product labels is a timeless principle to familiarize yourself with the characteristics of ingredients which you’re applying to your face to prevent any unwanted side effects.  Avoid scrubbing and over exfoliation as this will only add more irritation and inflammation and make your skin more susceptible. When you start with a clean canvas, there will be less dirt and oil trapped under the masks to potentiate a breakout. 2)  Keep a good fragrance and oil free moisturizer handy.  This hydrates your skin and provides a barrier, decreasing your skin’s vulnerability to physical factors such as friction and pressure. Make sure the moisturizer is not too heavy.  Lotions are typically lighter than creams.  Look for products like:  Cetaphil, Vaniply, Revision Hydrate, or AesthetixRx “Hydr8Rx”.  We like combination products which provide sun protection while also allowing for non-comedogenic hydration.  Revision Intellishade and Aesthetix Rx “MatteRx” which contain tinted zinc for a more matte, evenly pigmented look that won’t break you out.  This will help make it easier to… 3) Drop the makeup.  Makeup under a mask get trapped in the pores, clogging the follicle and leading to breakouts. 4) Clean your fabric masks if they’re washable, but stick to fragrance free laundry detergent such as “All Free & Clear”, “Tide Free & Clear”, or “Seventh Generation Dye & Fragrance free”.  Skin friendly laundry detergents don’t usually have a scent and should be clear to yellowish in color.  If you do use a detergent that has added fragrance and dyes, you run the risk of experiencing a skin reaction to residues which may irritate your skin or expose an underlying allergy.  Make sure you wash your masks after every use so that dirt and oil from your skin are cleansed, and any bacteria from your upper airway is disinfected before reusing. 5) If you know you’ll be wearing a mask for a while, you may want to find a more comfortable way to distribute the pressure of the elastic strap loop.  Women can attach the straps to a clip behind their head to take the pressure off their ears, and men can loop the straps through the adjustable back of a baseball cap. 6) If you do experience a breakout, don’t overdo it.  Squeezing, picking, over drying pimples with medications, and whatever other home made remedies you may come across can cause further irritation leading to inflammation and additional breakout and skin breakdown.  Start slow and go low, meaning:  either leave it alone, or lightly spot treat.  You can always revisit it the next day, and as long as the breakout isn’t instigated further, you should begin to notice some improvement within the week. If you are frustrated by acne, or if you’re experiencing “Maskne” and you’ve never dealt with an acne breakout before, consulting a dermatologist is the best way to ensure that you are treating acne and not folliculitis or a similarly presenting condition.  It is also helpful to determine whether or not you need prescriptive assistance.  A board certified dermatologist will be able to walk you through the factors effecting your skin and streamline the most effective approach for your skin type. Feel free to watch our Youtube video at:  https://youtu.be/l2E4PyPINqg for more of a discussion on this topic and other Covid related skin conditions if this is effecting you or someone you love. Stay healthy, happy, and safe!