'Maskne': Why your face is breaking out under your mask and how to stop it

If you're serious about protecting yourself — and others — from the very real dangers of Covid-19, you're...

Posted: Jun 25, 2020 8:51 AM
Updated: Jun 25, 2020 1:15 PM

If you're serious about protecting yourself — and others — from the very real dangers of Covid-19, you're wearing a mask when you go out around others.

For many people that is leading to an embarrassing and unpleasant side effect: blemishes, pimples, zits — or what dermatologists call acne.

'I have patients calling in despair saying 'What is going on? I've never had a breakout before and now my face looks like a teenager's!'' said board-certified dermatologist Dr. Whitney Bowe, clinical assistant professor of dermatology at the Icahn School of Medicine at Mount Sinai Medical Center.

'We're seeing lots of flares of acne, especially a type called perioral dermatitis, which tends to happen typically around the mouth and in the areas around the nose,' said board-certified Dr. Seemal Desai, an assistant professor at the University of Texas Southwestern Medical Center.

Breakouts that occur after wearing a mask have become so common that mask acne's been dubbed 'maskne' on social media.

'We think that wearing these masks, combined with stress from the pandemic, is causing an increased moisture-rich environment for bacteria and organisms to proliferate,' Desai said, 'causing a breakdown of the skin and flaring of some of these conditions.'

Nurses and other health care professionals on the front line of the battle against Covid-19 are hardest hit, Desai said, due to the seal needed from personal protective equipment in order to keep the virus at bay.

'I'm seeing lots more skin disease in health care workers because they're wearing PPE and N95 respirator masks that are causing ulcers, breakdown and bleeding of the skin,' said Desai, who is a spokesperson for the American Academy of Dermatologists.

Compared to the bruised and bleeding faces of doctors and nurses, a few pimples may seem inconsequential. But it's an important issue that shouldn't be trivialized, said Bowe, also a spokesperson for the American Academy of Dermatologists.

'Acne is significantly associated with self esteem, even if it's just one or two pimples,' she explained. 'Even having mild, minimal acne can have profound effects on interpersonal relationships, how we socialize, job performance, depression and anxiety.'

Acne mechanica

The technical term for maskne is 'acne mechanica,' and is the result of the mechanical friction of a fabric against the skin. It's not new — sports figures who wear helmets and chin guards are quite familiar with such breakouts.

'We all have these tiny little hair follicles on our face, chest and back, and wearing any kind of a mask or protective equipment that's creating friction and pressure can irritate the hair follicles and result in an acne flare,' Bowe said.

'That is compounded by moisture trapped underneath the fabric, which gets worse with humidity, with heat and with exercise,' she said.

If you haven't already experienced maskne, you very likely could as you spend more time outdoors this summer, due to the heat, humidity, sunscreen and facial products.

And treatment is tricky, experts say. You can't use powerful products like alpha hydroxy acids, chemical peels or Retin A to blast the acne because they will further damage the fragile skin barrier, making it more sensitive to the mask's irritating effects.

If you do use those products, 'you may not have blemishes, but you may end up with patches of eczema, dry patches, stinging, burning, inflammation, all signs of an impaired skin barrier,' Bowe said.

Of course the best thing to do is to prevent maskne from occurring in the first place. Since we can't — or shouldn't — stop wearing masks around others for the foreseeable future, here are some key prevention tips.

Wash that mask

Do you wear your mask about, then pull it off and toss it in a sunny spot in your car to kill the microbes (raising hand sheepishly)?

That might help kill the virus, but it breeds maskne, Bowe said.

'If you just lay it on your couch or put it in your closet and then put it on again in a couple of days, just think about all the microbes that have been growing in the weave of the fabric,' she said. 'It's dirty. If you've been wearing a little makeup, moisturizer or sunscreen it gets contaminated pretty quickly.'

Masks should be washed and completely dried after every use, Bowe advised, adding that she prefers cotton masks as they allow the skin to breathe.

'And if you exercise or sweat during the day with a mask on, then you want to change that mask and put on a fresh, clean mask right away,' she said. 'You don't want to sit in a sweaty mask, that will just breed more acne.'

Use gentle skin care products

'Good quality, simple skincare does not have to be the $500 fancy product. Just use light, gentle cleansers, non oily, not harsh,' Desai said.

'I tell people to avoid anything with SLS or sodium lauryl sulfate, which is a harsh sulfate that really strips the skin of its natural oils and impairs the barrier,' Bowe said. 'I also tell people to avoid any scrubs, anything that feels like sand or grit. Those are things you really don't want to be using because they're going to damage the skin barrier.'

Cleanse your skin twice a day, morning and night, she added, with the fingertips only.

'No instruments, no buff puff, no loofa, no washcloth, your fingertips are all you need,' she said. 'Pat your face dry with a clean towel, and put on a light moisturizer that is fragrance-free.'

Check labels carefully when it comes to fragrance-free products, Desai suggested.

'Having less fragrance does not mean fragrance-free,' he cautioned. 'Don't buy them unless it says fragrance-free on the label. It's very easy to get tripped up on that.'

Don't use heavy ingredients, like cocoa butter or coconut oil, and skip any kind of oil-based foundation, Bowe said.

'If you can go foundation-free and use a mineral sunscreen instead during the summer, I think that's really the way to go,' she said.

Wait 15 minutes after applying moisturizer or sunscreen before you put your mask on, 30 minutes if you are wearing an N95 mask, she suggested.

'You really want those ingredients to soak into the skin If you're going to try to create that seal,' Bowe said. 'If your skin is slippery, the seal is not going to work as well.'

Use lip conditioners with more of a waxy finish or a lip serum to hydrate the lips while you're wearing the mask, Bowe added, but not a lip gloss or anything that might stick to the mask.

Finally, at night after cleaning with gentle products, it's OK to put on a moisture-rich cream to repair the skin barrier and hold in moisture, she said.

Put that new skin care regimen on hold

If you do use anti-aging products, be careful that you're not overdoing it, Desai said, for the same reason that it's not a good idea to use them to clear acne.

'You don't want to end up with something that is an open area on the skin, and create a breakdown, tear or stress-induced flare.'

This is also not the time to take up a new skin care regimen.

'I get people telling me all the time, 'I've used that same makeup for 25 years! I don't know why it's causing a problem now.' It's because your skin is more prone to having an immunologic response,' he said.

Even if your skin is not sensitive to fragrances or your previous skin care, Desai explained, you are wearing a mask, likely anxious about Covid-19 and possibly using more PPE-like equipment. All that stress can cause your skin physiology to change.

Another reason, Bowe said, is that putting a mask on top of a fragrant cream or new makeup will cause more of those ingredients to come in contact with the deeper layers of your skin, thus triggering inflammation — sometimes even if you're using products labeled 'natural.'

'There's a huge misconception among my patients that natural is always better,' she said. 'But a lot of my patients are reacting to these natural products that have botanicals and essential oils in them.

'So if you use a product and you smell a fragrance, even if it says fragrance free, that's when you probably don't want to use it underneath the mask.'

Don't use petroleum protection

Many of us might reach for a soothing heavy cream or petroleum jelly to smear on our faces where our mask rubs — but that's a mistake, especially for anyone who needs to wear protective gear, Desai said.

'Petroleum products and a lot of these things can actually interfere with the integrity of the mask and the seal,' he said.

'If you have skin breakdown, ulcers or erosion from your personal protective equipment, talk to a board-certified dermatologist because there are products that can be prescribed to help.'

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