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As more places and businesses begin to open and wearing masks becomes routine, your skin may develop “maskne,” a term used to describe acne in the area a mask is worn.
A similar acne response is often common with helmet straps and seen in acne-prone football players and cyclists. It is also similar to what wearing thick makeup does to dancers/actors skin.
The most common issue is facial redness in the geometric distribution of the mask, with the greatest prominence at the border, so people get a lovely oval red outline.
These areas are usually tender to the touch and any cream/lotion one would apply stings, as the skin barrier has been disrupted and in the setting of inflammation, the sensory nerves are hypersensitive to external stimuli.
What causes maskne?
While acne is one trigger for maskne, it may be a bucket term for a few conditions caused by wearing a mask.
Acne mechanica
Physical manipulation and pressure of a mask on the skin triggers acne. With the combination of friction, occlusion, and emotional stress of COVID-19, you have a perfect recipe for acne. Being a chronic inflammatory disease resulting in chronic skin barrier disruption, any stress on the skin or system overall can exacerbate this condition.
This is because stress is known to trigger facial flares of acne, eczema, seborrheic dermatitis, and rosacea.
The pathways by which stress leads to these conditions is not entirely understood, but hormonal responses to stress may play a role. Mask wearing tends to worsen skin maladies. Together, stress and masks act synergistically to worsen facial skin disorders.
Miliaria
Also known as heat rash, miliaria can result from occlusion and sweat under the mask. Mask wearing leads to local alteration of the skin microbiome. With mask use, the covered skin is subjected to elevated CO2 levels, increased humidity, higher temperatures, and more bacteria and microorganisms from the mouth and respiratory system.
Unlike acne, which is more immunologically complicated, miliaria directly results from the immune system responding to trapped dead skin cells, bacteria, and sweat salts in the openings of the skin where they don’t belong.
Rosacea
In addition to triggering acne flare-ups, alteration of skin microbiome by masks can worsen or trigger rosacea, perioral dermatitis, as well as seborrheic dermatitis, a dandruff-like facial redness with scaling. While certain features of rosacea can mimic acne, rosacea is different.
Rosacea is a unique chronic inflammatory disease that results from skin barrier dysfunction, an overactive local immune response, and hypersensitive nerves around the blood vessels causing them to widen persistently, resulting in chronic facial redness. The same issues arise with wearing a mask all day in terms of disease exacerbation.
How to prevent and treat maskne
Here are a few ways to care for your skin while wearing a mask.
Apply emollient
Skin irritation with masks is most common along the bridge of the nose and central cheeks, where the flexible nosepiece is secured into place. This can be minimized by using a thicker emollient, such as Aquaphor, in the area to augment skin barrier function and provide lubrication for the junction of the mask with the skin.
Moisturize
Dermatologists recommend lighter consistency moisturizers, ideally with anti-acne ingredients, such as retinol and purified nano-sulfur. This is because one of the central issues that arises from wearing a mask all day is skin barrier injury.
For diseases like acne and rosacea, this both instigates and propagates the abnormal inflammatory response. So, first things first, restoring that skin barrier is key. This means applying an oil-free moisturizer to damp skin multiple times a day. Next, regulating inflammation and slowing down skin turnover is very important while wearing masks.
When the skin is inflamed, itching occurs which in the setting of acne is even more problematic, as this can result in clogged pores, further worsening the condition. Topical retinoids are ideal for treating this.
Because all retinoids can be drying and irritating when you first start using them, one can ease into using them by applying a pea-sized amount to the entire face and dry skin every other night for several weeks.
Cleanse and exfoliate
When you remove your mask, gently cleanse and exfoliate your face.
Also, make it a routine to clean your masks once you take them off as recommended by health professionals, which states that cleaning cloth masks in the washing machine is sufficient.
Certainly, the buildup of oil, dead skin cells, and other debris can be irritating to the skin among other things. More importantly is external exposures, which are particulate matter that hits the outside of the mask, which is protecting you. This needs to be cleaned well.
Use prescription medications
For more moderate to severe exacerbations, there are prescription medications your dermatologist can prescribe for your relief. Ignoring skin conditions can lead to more severe skin problems.
Persistent irritant contact dermatitis increases the risk for skin infection, and constant rubbing and irritation can elicit a herpes cold sore outbreak in those that get them, but this is not the biggest and most persistent issue.
Chronic inflammation can lead to long-standing skin discoloration, called post inflammatory pigment alteration, especially in dark skinned individuals. There are some amazing treatments for this disfiguring outcome, which can be quite disabling if not treated on time.
