Maskne Treatment and Prevention: The Ultimate Guide

Maskne is a challenge that has dramatically increased because of the number of people wearing face masks for personal or professional protection. Called acne mechanica, maskne is a form of acne that develops due to a combination of friction and moisture. It's often seen in people who wear sports gear like helmets and chin straps. 

The type of masks I wear in the ICU and the amount of time I spend wearing them has caused me to revamp my entire understanding of skin health. My beauty routine went through several overhauls before I got it right. 

Facial Skin Issues Caused By Masks

Skin issues caused by masks are divided into two categories: mechanical and infectious/inflammatory. Both can occur at the same time on different parts of your face.

Mechanical Damage

The mask itself causes this type of skin issue. A combination of pressure and friction causes physical injury to the skin. The amount of damage is determined by the kind of mask, duration of use, and how it fits.

Facial injuries from masks can happen to anybody, but this is more common in healthcare workers and first responders due to the type and intensity of mask-wearing needed for their jobs.

The most common areas for mechanical damage are along the lines where the mask seals (bridge of the nose, across the cheekbone, around the jawline) and the back of the head or ears (from strap pressure). The injuries may include blisters, friction burns, and pressure ulceration.

The most important thing is to act quickly when you feel a pressure spot or pain starting. Your mask must fit properly. Some pressure-relieving dressings exist, but using them could inhibit your mask seal and put you at risk.

If you're wearing masks as part of your job, start by talking to your manager or getting assessed in your occupational health or mask-fit-testing department. You may need an different type of mask or some other treatment to keep your face healthy while still being protected from COVID. 

What is Maskne?

Maskne is the term used to describe infectious and inflammatory skin issues from wearing face masks. It includes:

• Acne: Acne occurs when your pores are clogged with oil and dead skin cells. You may experience whiteheads, blackheads, or pimples. 
• Rosacea: While wearing a mask doesn't cause rosacea, it certainly can cause flare-ups and an increased chance of skin damage.
• Perioral dermatitis: inflammation and damage focused on the area around the mouth. It may be pustular, red, dry, cracked, or scaly and crusting.
• Atopic or irritant dermatitis: an allergic reaction or sensitivity to the material in your mask can cause a red rash, skin irritation, and blisters. People with damaged skin barriers are at greater risk. 
• Folliculitis: an infection of the hair follicles. It can cause bumps that look similar to an acne breakout. 
• Infections: superimposed bacterial or fungal.

Typical acne affects either your T-zone or U-zone. T-zone acne is seen often in people with oily skin because that's where the largest number of sebaceous glands live. When the U-zone is involved (cheeks and jawline) it could be related to overly dry skin, friction from pillow-cases, and possibly hormonal fluctuations.  The M- zone for acne is a newer concept and is attributed to wearing masks. 

What Causes Maskne?

Skin likes a consistent environment and gradual changes. The rate of cell turnover and your natural oil levels adapt and get used to a specific routine. When you have a good balance, it's easier to keep your skin healthy and predictable.

Add mask-wearing into the equation, and literally, everything changes.

Your face is now enclosed in synthetic fabrics that cause damage from friction. As a result, all the natural shedding of dead cells that occurs when your skin is out in the open air stops. While in your mask, these dead cells clump up and remain in place and get bathed in your warm, humid breath. This makes preventing breakouts much more difficult.

A warm, humid environment full of layers of dead skin cells creates a perfect location for yeast, bacteria, and skin mites (Demodex) to flourish. 

Principles of Prevention and Treatment

Luckily, the same important strategies for maskne treatment are used when you're trying to prevent getting maskne in the first place. Unfortunately, many people end up with damage before they have a chance to take preventative measures. 

Proper fit and early intervention are critical to prevent maskne. Act rapidly if you start noticing tender pressure points, clogged pores, or congested skin. Most of the same tips to treat maskne are useful for maskne prevention too.

Starting with the worst-case scenario, you need to know when to see your primary care physician or a board certified dermatologist. Also, if it's related to your job, you may need to visit the occupational health department where you work.

Like any skin issue, maskne can become bad enough to need medical attention. You may need medical treatments like topical steroids, topical antibiotics or antifungals, or even oral medications. If things are severe, don't try DIY remedies. If you're already under treatment for a skin condition like eczema or psoriasis, review your maskne plans with your doctor.

10 Most Important Methods to Treat and Prevent Maskne

Your usual skincare routine might not work anymore. In fact, you may even change from having one skin type to another.  If the changes to your skin are manageable, then these tips will help get you on track:

#1: Make-up

Makeup is not a great idea if you wear masks for long hours. Jazz up your eyeshadow and mascara, but skip the foundation, concealer, and blush on heavy mask days.

#2: Clean Masks

If you wear cloth masks, be sure they are fresh.Washing your masks with an unscented detergent for sensitive skin is important. If you use disposable masks, be sure not to reuse the same ones. Always change them if they're soiled or soggy.

#3: Take Mask Breaks

If you wear N95 or reusable industrial respirators at work, try taking a 10-15 minute mask-free break every 2-4 hours.

#4: Change Your Cleansing Rituals

• Cleansing is important, but gentleness is key. Having a damaged skin barrier will make the chance of acne or dermatitis higher.

• Mornings and daytime: wash your face with lukewarm water and a very soft washcloth without rubbing. Think of this as a gentle rinse to refresh, not a deep clean. Do this when you take your mask-free breaks.

• At the end of the day: use a gentle cleanser like a lotion or balm.

• Always let your skin dry completely before putting a mask back on.

• If you have oily skin or acne prone skin, plain water might not be enough. Stick with using a gentle cleanser more frequently over a stronger one less often. Over-cleansing will do more harm than good.

#5: Moisturize

Moisturization is important. Depending on your skin, you might want to use a light oil-free moisturizer. However, if your skin is dry or damaged, a cream or a face oil are fine. Look for non-comedogenic ingredients and avoid pore-clogging oils like marula oil and coconut oil. Something like squalane would be perfect for many people, but there are many face oils for acne.

#6: Consider Barrier Creams

If you need extra protection from friction, silicone barrier creams may help, as long as they don't affect your proper mask seal. Some people have great results from a very thin layer of petroleum jelly. Try squalane or shea butter if you're looking for a more natural alternative that is unlikely to clog pores.

#7: Simplify

Take a skinimalism approach if you can. Fragrance-free is very important. Reduce your active ingredient use, especially retinol and chemical exfoliants. If you know specific ingredients work for you, stick with what you know. However, be aware that sometimes ingredients that used to be fine can suddenly become irritants. 

#8: Treat Your Face in Zones

Think of your face as having different zones, each with their own skincare regimen.

• If the bridge of your nose and cheekbones are damaged by friction, those areas need TLC only - water, pat dry, moisturize - nothing more.

• If your chin area is breaking out with accumulating dead, flaky cells, use mechanical exfoliants like a gentle konjac sponge, then moisturize.

• Spot treatments with medicated ingredients like salicylic acid and benzoyl peroxide should be used sparingly as they increase the chance of contact dermatitis when underneath a mask. Put a few dots on your spots before bed if needed. 

#9: Use Soothing, Protective Ingredients

Gentle ingredients that should be useful for most people: ceramides, colloidal oatmeal, allantoin, bisabolol, and aloe. These types of ingredients with emollients will help strengthen your skin barrier. 

Consider probiotic supplements or skincare that contains prebiotic ingredients to help boost the health of your skin's  microbiome. 

#10: Don't Quit Sunscreen

Sunscreen is always important and shouldn't be skipped. Mineral-based options might be less likely to clog pores for some people. Others will do well with a light lotion.

Sustainability and Mask Wearing

Face masks are contributing to plastic pollution. One estimate is that 1.56 Million face masks will be entering the oceans by 2020. The Covid-19 pandemic is estimated to generate 7,200 tons of medical waste daily. So much of this is from masks, and these masks all contain plastic and will degenerate into microplastics.

We need reusable and sustainable options since mask-wearing, especially in healthcare, is here to stay.

bareLUXE Skincare is a Green Beauty brand that elevates simple carrier oils into advanced oil serums using active botanicals.