Have you heard the saying, “Not all superheroes wear capes?” That has never been truer than it is now with caregivers risking their lives each day to protect others. Whether you’re a medical professional or you’re just wearing a mask to pick up dinner, the U.S. Dermatology Partners team agrees about one thing – not all superheroes wear capes, but right now, they all wear masks! Thank you so much for choosing to prioritize the health and safety of others by wearing a facemask and following other guidelines from the Centers for Disease Control and Prevention (CDC).
Unfortunately, regular mask wear can lead to skin health issues, including flareups in chronic skin conditions. You have likely heard of acne, a common skin condition that impacts millions of adolescents and adults in the U.S., but what about “maskne?” Is maskne, acne related to wearing face masks during the coronavirus disease (COVID-19) pandemic, really a thing? If you’re keeping up with the latest articles about skin health issues related to COVID-19, you’ve almost certainly heard the word ‘maskne.’ This term is coming up in a lot of self-care blogs and in health magazines referencing a type of acne that develops due to friction against the skin. If you’re dealing with breakouts caused by frequent mask wear, your dermatologist can help you prevent and treat this condition.
What is Acne?
Acne is a skin condition that occurs for many reasons. Most commonly, acne is caused when pores are clogged with sebum (oil), skin cells, sweat and moisture, dirt, and other foreign matter. These clogs can trap Propionibacterium acnes (P. Acnes) bacteria, which naturally occur on the skin, to be trapped beneath the skin’s surface, causing infection, inflammation, and the development of “pimples.”
What is Maskne, and is it Different?
The type of acne most people think about when they hear that word is caused by a combination of clogged pores, hormones, and C. acnes bacteria, but this is only one form of acne. Another common form is known as “acne mechanica.” This type of acne is caused by occlusion or friction against the skin that leads to skin irritation in the short term. Over time, continued friction leads to inflammation that can block pores and lead to breakouts. The moisture and sweat trapped on the skin when wearing masks for an extended period can also contribute to these breakouts. Maskne is a form of acne mechanica that causes breakouts in the areas covered by a face mask – the jaw, cheeks, nose, chin, and around the mouth. Before the COVID-19 pandemic, athletes who wore helmets were most frequently afflicted with this condition.
In addition to acne, mask use may also cause flareups of other skin conditions such as rosacea or perioral dermatitis. Perioral dermatitis is a skin condition that causes irritation, inflammation, and pimples around the nose and mouth. All of these conditions require a specialized skin care routine to limit symptoms and avoid unnecessary flareups. If you notice signs of maskne, you should work with your dermatologist to create a care plan as soon as possible.
What Causes Maskne?
Numerous factors may lead to the development of maskne. The friction from wearing a face mask for extended time periods is the most obvious, but other risk factors for maskne include:
- Makeup – Wearing makeup under your face mask increases chances for clogged pores and acne mechanica breakouts.
- Humidity – The heat and humidity from breathing into a mask are challenging enough on their own, but with the increased temperature and moisture in the air during the summer months, people are much more likely to experience breakouts too. In addition to causing breakouts, heat and humidity make the symptoms more severe, leading to deeper, painful types of pimples, including nodules, papules, pustules, and cysts.
- Cold, Dry Weather – Unfortunately, the change of the season is not likely to offer much relief for maskne sufferers. Skin is likely to be naturally drying during the fall and winter seasons, and the friction from the mask will more quickly remove the skin’s natural oil barrier. This dryness and repetitive motion can lead to a breakdown in the skin, and the hair follicles may break open instead of clogging the way they do in the summer. This can lead to folliculitis, a bacterial infection of the hair follicles in addition to surrounding pores clogging with the shedding dry skin cells.
- Stress – Stress causes an increase in the production of cortisol and other hormones. This spike in hormone production taxes the immune system, and when our immune system is tired, the body starts rerouting its resources away from the skin, increasing skin health symptoms and taking longer for issues to be resolved.
- Sunscreen – You still need to apply sunscreen every day, especially if you’re going to be outside for long hours, but this added layer of protection is also an extra product on your already irritated skin, which can contribute to clogged pores. Choosing a lightweight sunscreen or a facial moisturizer with built-in sunblock can help to minimize the number of potentially pore-clogging products beneath your mask.
Is Increased Face Mask Wear Causing Other Skin Health Concerns?
In addition to clogging pores, the friction from mask wear also breaks down the protective barriers of skin more quickly. The surface of the skin has a microscopic layer of protective oils and fats that maintain moisture levels; promote general skin health; and keep skin safe from external irritants, toxins, and bacteria or viruses. When this protective barrier is broken down, more serious or more frequent flareups in chronic skin conditions like rosacea, eczema, and psoriasis. This can make managing your skin health more challenging. Those who already have sensitive or dry skin may also see more serious issues related to mask wear and have more difficulty controlling their symptoms.
COVID-19 has changed many things about our daily lives. Wearing face masks is one of the most pervasive changes. For people who struggle with acne and other chronic skin conditions, the added heat, friction, and moisture under a face mask can be a recipe for bad breakouts and flareups. If you already struggle with a skin condition, wearing a mask can exacerbate your symptoms, so make sure you’re working with a dermatologist to create an ongoing care plan.
The lips are one area that many patients neglect, but they are likely to be one of the areas most impacted by mask wear. Make sure to apply lip balm or protective petrolatum ointments (petroleum jelly) to the lips to protect them from mask irritation and dryness.
Does the Type of Mask Make a Difference?
Out of the University of Illinois conducted by mechanical science professor Taher Saif and two graduate students, Onur Aydin and Bashar Emon, indicates that your old t-shirts may be the best material to create masks that effectively prevent the aeration of respiratory droplets. A face mask made of one layer of regular cotton blend t-shirt material can decrease respiratory droplets by 40% and a double layer of these breathable materials offers 98% droplet reduction. For non-healthcare industry individuals who practice social distancing, face masks made from breathable cotton materials should be both effective and comfortable.
In addition to switching to a more breathable cotton fabric when possible, you may also want to look for face masks that are created from materials that will minimize friction. Specifically, silk or silk-lined face masks will significantly reduce rubbing and irritation that can increase the risk for acne mechanica breakouts. No matter what fabric you choose, frequent washing is essential.
Can I Prevent Maskne?
When people know the cause of their breakouts, the easy answer is to say – stop doing that, but that’s not an option for many people right now. If you can spend more time at home and limit your mask wear, that’s great, but if not, there are still steps you can take to prevent breakouts or at least reduce the severity. Your first step should be to contact your dermatologist to schedule a checkup and discuss your treatment and prevention options, and generally, to ensure maskne is your concern and not something else.
In addition to working with your dermatologist to develop a care plan, you should keep the following maskne prevention tips in mind:
- Clean your reusable masks – You need to wash your mask frequently. If you’re wearing a mask for a few minutes, you can probably hold onto it to wear again later, but if you wear the face mask for an hour or longer, wash it and switch to a different mask. Use hypoallergenic clothes detergent to wash your face mask as residue from these products can also irritate the skin.
- Exchange disposable masks often – We know with supply shortages early on, many people were reusing disposable masks, and if you’re desperate, this is better than nothing. However, reusing disposable masks isn’t ideal from an efficacy standpoint or to prevent skin concerns. You should at least get a new face mask each day, and any time your mask is damaged or appears visibly dirty or damp.
- Simplify skincare – The more products applied to the skin below a mask, the more likely people are to experience irritation and breakouts. Use a gentle cleanser to wash the face in the morning and evening, apply a fragrance-free moisturizer regularly, and use sunscreen as directed. When possible, find a moisturizer for the face that has sunscreen built in to further reduce the number of products. Check your ingredient list for oils, fragrances, and other ingredients that present potential concerns. Consult with a dermatologist for personalized recommendations, but as a good rule of thumb, skincare products with fewer ingredients are typically not as tough on your skin.
- Use a petrolatum-based product for protection – To create a barrier between the skin and the places the mask rubs most (the outside edges of the mask), apply a small amount of petroleum jelly. This will keep skin moisturized and reduce irritation. This should only be done for cloth face coverings. Petrolatum products can damage the integrity of disposable face masks, so don’t petroleum jelly if you’re using face masks made from paper or other single-use materials.
- Avoid harsh products – If you’ve ever applied lotion then put on a pair of gloves to help “seal in” the moisture and keep dry hands from becoming chapped, you know that covering treated skin increases the efficacy of the products you apply. This works for moisturizers, but it also works for other skincare products. Skincare treatments with retinols and acids can be a great part of a treatment plan for acne-prone skin, but for people with maskne, the effects of these products are likely to be amplified under the face mask. This leads to irritation, dryness, and other adverse effects. If you want to continue your retinol, alpha hydroxy acid, and other skin treatments, consider applying these only at night when you’re done wearing your mask for the day.
- Skip the makeup – We all want to look our best, but foregoing your makeup routine can significantly reduce the risk for clogged pores and skin irritation under your mask. If you do wear makeup, minimize your routine and use a gentle cleanser or micellar water to remove the makeup. In addition to irritation and breakouts from the medication itself, overly powerful and stripping makeup removers can irritate skin unnecessarily.
- Pay extra attention – While you’re wearing a mask, make a change right away when you notice irritation, excess moisture, pain, or other concerns. We know healthcare workers can’t always excuse themselves to apply a little petroleum jelly around their mask lines, but as soon as reasonable, excuse yourself to make an adjustment if you notice issues. Don’t just live with irritation or discomfort all day. In many cases, excusing yourself to your car or another place removed from others to take a few mask-free minutes can offer significant relief and reduction in symptoms.
- Consider mineral sunblocks – Many mineral sunblocks contain zinc, which has anti-inflammatory properties, choosing one of these products can help to protect skin from sun exposure while minimizing irritation.
What Strategies Should I Use to Combat Maskne at Home?
Many of the strategies we typically use to combat acne can be further irritating or inflaming for people struggling with acne mechanica – aka maskne. The treatments we may normally recommend may not necessarily be the right choice for these patients. Even if breakouts clear up, very drying or harsh treatments may leave you extremely dry skin, eczema flareups, or sores from the mask rubbing against skin. If you struggle with acne, your regular treatment plan may not be effective, so it’s important to talk to your dermatologist to adjust your daily skincare routine to combat maskne.
Some recommendations for combating maskne at home include:
- Use a gentle cleanser and facial moisturizer suitable for your skin type. Moisturize as needed throughout the day.
- Spot treatment – At night, after you’re done with your face mask for the day, use a benzoyl peroxide spot treatment of 2.5% to 5% concentration directly on pimples. Clean any excess benzoyl peroxide from your skin in the morning before putting on your mask.
- Retinols – If you do use a retinol treatment for breakouts, apply these products only at nighttime when you won’t be wearing the mask anymore, and be sure to completely clean them from the skin and apply a moisturizer before putting on your mask in the morning.
- Combat hyperpigmentation – For people of color, maskne can cause hyperpigmentation (skin darkening), so using glycolic acid-containing products, such as exfoliation pads, can help to combat the pimples and skin darkening. To ensure proper use, consult with a dermatologist, especially if you plan to use these products frequently or for more than a few weeks.
- Sunscreen – Applying sunscreen also helps to prevent unnecessary damage and irritation from the sun, and for people of color, sunscreen can help to reduce the risk for hyperpigmentation.
- Hydrocortisone cream – While cortisone shots are used to shrink large pimples, hydrocortisone cream needs to be used intentionally and only under the advice of a dermatologist. Used improperly, hydrocortisone can actually exacerbate maskne breakouts.
- Apply a barrier – After cleaning and moisturizing your skin each morning, apply a thin layer of barrier ointment to the inflamed, irritated, or damaged areas of the skin (petroleum jelly works well). Allow the barrier agent to sit for a few minutes before putting on your mask. This step is typically not recommended if you are using disposable masks.
When is it Time to See a Dermatologist for Maskne Treatment?
We will do our utmost to help people struggling with maskne to develop a good skincare routine to tackle this issue on their own, but for those who have very deep pimples and cysts or painful breakouts, it may be time to come into the office for more advanced treatments. You should also visit a dermatologist at least once each year for a skin exam to check for warning signs of cancer, keep track of chronic skin conditions, and ensure you’re using the right skincare products.
Visit U.S. Dermatology Partners for Maskne & All Your Skin Health Needs
Whether you’re struggling with maskne or just need to schedule your annual skin exam, U.S. Dermatology Partners would love to hear from you. We’re happy to offer in-office visits, and you can schedule your next appointment using our simple request form. Once we receive your request, one of our dermatology team members will be in touch to discuss your appointment options. We look forward to speaking with you soon.
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