As the world crosses the six-month mark in managing the COVID-19 global pandemic, we’re tasked with responsibly creating a “new normal”, well also preventing the spread as much as we can. We’re finding ways to maintain a new routine, balancing work, home, and family, and ultimately finding a way to make it through this difficult time in one piece. One thing that’s not going away anytime soon? The importance and need to wear a facemask at all times while moving around in public. But what happens when wearing our masks works well to protect us and others from the spread of COVID-19, but also creates undesirable side effects we aren’t used to? I’m talking about maskne – a cute name for a not-so-cute problem. As if 2020 wasn’t full of enough drama, this year has sprinkled in the experience of teenage-era Acne. 

What is maskne?

Simply put, this is the acne-like rash you may be experiencing as a result of frequency mask use, with breakouts occurring along or within the masked area of your mid and lower face. It’s become so prolific that it’s received its own name on social media! These breakouts can be caused by the friction between your mask and Skin, in addition to the constant moisture that occurs under your mask from your breath. Friction, oil, and dirt aggravate your skin, trap this moisture, and can cause perioral dermatitis, a facial rash around the mouth. The affected area can become red, scaly, bumpy, itchy, and/or may burn and spread to other areas. 

While the phenomena aren’t new – athletes have always experienced this from their helmets or chin guards rubbing their skin, it’s definitely more widely experienced as we all focus on protecting ourselves and our communities from COVID-19. For those of us who already have skin conditions, the regular use of masks may exacerbate the problem areas. For those of us who haven’t had acne in some time (or ever), we’re joining the club! Regular mask use can cause acne-like conditions to develop even if we haven’t experienced them in years, especially if we’re wearing masks for long periods of time in the day, like healthcare workers on 12-hour shifts or wearing them regularly through the week, even if it’s just a few hours a day each day. 

The technical and less-catchy term for maskne is “acne mechanica,”, and refers to the mechanical friction between fabric and your skin. The hair follicles on our face, in this case, are irritated by this friction and flare up resulting in the acne we see and feel (4). The combination of this friction, oil, dirt, sweat, and moisture causes the irritants and can spread across the masked area, and even up towards the eyes and forehead in some instances. 

Who can be affected by maskne?

While teenagers are already typically dealing with acne during hormonal increases, maskne is affecting more than teens, and just because it looks like acne doesn’t necessarily mean that’s what it is. We all can get acne and related-skin disorders, and those already dealing with some kind of skin irritation are likely to experience an increase from regular mask use. Acne vulgaris, a skin condition caused by blocked hair follicles by dead skill cells oil, or bacteria, usually affects teens and adolescents, peaking around age 20. 

Rosacea, however, is another common skin condition, causing redness and visible blood vessels in the face, most commonly affecting middle-aged women (1). For those already suffering with rosacea, frequent mask use may exacerbate the production of small, red, pus-filled bumps on the skin. 

Perioroal Dermatitis, like Rosacea, is characterized by bumps and redness, but in this case, it primarily occurs around the mouth, the creases between the nose and mouth, and areas around the nose. The cause of periorificial dermatitis is unknown, but young women are the most likely to suffer from this condition, and it may occur after using face creams containing steroids (2). Not surprisingly, health care workers on the front lines of the pandemic often report experiencing skin irritation after wearing their masks all day, and those in more humid environments will be affected more severely. In these instances, it’s likely some variation of this dermatitis, although not always. 

How can you prevent or treat maskne?

1 – Change your mask regularly! If you only have one, wash it daily! 

Reused masks contain oil and dirt from the day before, and will only continue to compound as you continue to wear it, becoming more and more of a breeding ground for bacteria. If you are using dispensable masks, make sure you throw them away at the end of the day – don’t be tempted to hold on to them for another day’s use. Your skin will thank you. If you use cloth masks, make sure you wash them at the end of the day, preferably with a non-scented cleaner that you know you aren’t sensitive to. 

2 – Find ways to control or limit the friction between your mask and your face.

Wearing a mask that fits you properly can make all the difference, so mark sure it’s not too loose, but it’s also not too tight. The key here is to check in with the fit early on to make sure it’s not rubbing your face too much or too often, and you aren’t having to touch it to reposition through the day. A well-fitted mask should “hug” your face, cover your nose, cover your chin, and have no obvious gaps around the edges. This can be tricky since everyone has a different face shape, so try a few different designs to see what works for your specific shape best and feels the most comfortable. Your mask should also stay in place as you move and speak. If you’re having to readjust it often, it’s probably not a good fit. 

When selecting which fabric or material is best for your mask, you’ll need to make sure the fabric is comfortable and won’t irritate your skin, but is also an effective mask that will still work properly to prevent the spread of COVID-19. The CDC recommends using two 10” x 6” pieces of rectangle-cut cotton fabric if you’re making your own mask, and have provided sewn and non-sew instructions for homemade masks here. 

3 – Limit other irritants that can cause acne and maskne. 

This is a good opportunity to evaluate your overall skincare routine because there are likely other areas you can improve on that are currently making you susceptible to acne, even without a mask. There’s no better time to overhaul your skincare regime. Follow these basic guidelines to ensure you’re treating yourself well. 

• Do not use benzoyl peroxide under the mask
• Avoid red dye, tartar control toothpaste, and tooth whiteners
• Avoid dirt build-up, and consider washing your masks with an anti-dandruff shampoo or sulfur bar cleanser. This type decreases skin yeast growth, which can aid in preventing acne (and maskne!)
• Limit (or eliminate) makeup.  
• Wash your face at least two times per day. 
• Consider medical microdermabrasion and other exfoliating treatments. 
• Teenagers can see a dermatologist for a prescription for Soolantra cream (ivermectin, Galderma), which has antiparasitic properties (3). 

Perioral dermatitis is the most common type of irritant facial acne, and it’s likely that many of those affected by maskne today are experiencing a variation of this type of dermatitis, caused by skin and follicle irritation and yeast build up. If you suspect you’re one of them, there are additional actions you can take that may be helpful. 

• Eating yogurt or taking probiotics daily.
• Try using diaper cream on the skin, underneath your mask
• Limit moisturizers – moisture is one of the main factors contributing to maskne! 
• Try an anti-yeast cream in the affected areas, such as Clotrimazole.

If it’s causing problems, why is it important to continue wearing a mask?

Wearing a face mask is one of the few effective measures to prevent the spread of COVID-19. We know it can be irritating – both in practice and for your skin, but we’re all in this together! And with a few adjustments to our daily skincare regime, we can combat the negative side effects and focus on getting through the global pandemic healthier and more glowing than ever. 

1 2019. Rosacea. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/rosacea/symptoms-causes/syc-20353

815.

2 2019. Perioral Dermatitis. https://www.mountsinai.org/health-library/diseases-conditions/perioral-dermatitis.

3 Forand, Rebecca L. 2020. Q&A: Treating ‘maskne’ in the COVID-19 era. https://www.healio.com/news/dermatology/20200724/qa-treating-maskne-in-the-covid19-era.

 4 Mills OH Jr, Kligman A. Acne mechanica. Arch Dermatol. 1975 Apr;111(4):481-3. PMID: 123732.

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