Masks have become an essential part of our day - we don’t leave the house without them. Wearing a mask is needed for preventing the spread of COVID-19. But as a result of prolonged mask-wearing, many people have experienced ‘maskne’ or mask-related acne.  

Wearing masks for prolonged periods greatly impacts our skin. It affects our skin microbiome - the normal balance of good microbes that help keep our skin healthy. It also affects our level of hydration and transepidermal water loss, pH, and sebum production (the normal oils that our skin produces).

These changes have dramatically affected all types of skin dermatoses, acne being the one most commonly seen. There’s even a term coined for it: “Maskne.” 

What Causes Maskne?

Maskne is essentially a subtype of acne mechanica. It is a disorder of follicular occlusion and is directly related to two underlying factors:

1) Mechanical stress caused by pressure, occlusion, and friction 

2) Skin microbiome changes due to changes in heat, pH, and moisture from biofluid. 

What Are the Symptoms of Maskne?

It has been suggested that mask acne should be diagnosed when: 

1) Acne occurs within 6 weeks of wearing a regular face mask

2) Pre-existing acne worsens in mask-covered areas after regular mask-wearing.

3) Other facial dermatoses can be excluded 

Masks induce microenvironment changes in the skin by dehydration, increased sebum, and elevated pH. These are pro-comedogenic factors that promote the growth of acne-producing bacteria known as Cutibacterium acnes. This triggers an inflammatory response resulting in the formation of acne lesions such as papules and pustules. 

How Should Maskne Be Treated?

Some ways to prevent Maskne include:

1) Wear reusable cloth masks instead of disposable ones. Wash them daily at high temperatures to rid bacteria and dirt build-up.

2) Wear cloth masks made of natural fibers, like cotton, that is soft and breathable. Bio-functional textiles, which can sense and respond to environmental changes are ideal. 

3) Use gentle cleansers with active antibacterial agents to maintain a healthy skin microbiome.

4a) Use moisturizers that are serums, mists, or cream-based.

4b) Use hydrogel prescription formulations of antibiotics and retinoids which reduce irrigation resulting in better drug tolerance and efficacy.

5) Apply sunscreen, preferably mineral sunscreens, and use ultraviolet protection factor UPF 50+ fabric masks.

REFERENCES 

1. Damiani G, Gironi LC, Grada A, et al.
COVID-19 related masks increase severity of both acne
(maskne) and rosacea (mask rosacea): Multi-center, real-life,
telemedical, and observational prospective study. Dermatologic
Therapy. 2021;e14848.
2. The “Maskne” microbiome – pathophysiology and
therapeutics
Wan-Lin Teo, MBBS, MRCS (UK), FAMS (Dermatology
International Journal of Dermatology 2021