The COVID pandemic led to a few changes in our daily habits – such as washing hands frequently, keeping 6′ social distance, and wearing masks. Wearing masks was shown to reduce the risk of respiratory infections which are commonly spread through droplets (ie. sneezing, laughing, coughing). With this new habit of mask wearing, many people started to develop a condition called mask-acne. Today we will discuss – what is mask-acne?
Mask-acne is a term for several different skin conditions
Mask-acne is a term that patients used to lump all types of skin conditions that develop under the masks. Although there’s many different possible medical conditions that can develop, the most common presentations are: acne or folliculitis, irritant contact dermatitis, and allergic contact dermatitis.
Mask-acne due to microflora overgrowth
There’s some evidence that wearing masks can lead to increased oil production. Under masks, the skin’s temperature is higher. Studies show that with each 1°C rise in temperature, sebum increased by 10%. Further, the humidity and heat under masks can lead to irritation and swelling of the top layer of the skin (aka epidermis) which then leads to blockage of the pilosebaceous units that may contribute to acne production. More oils, warmer temperatures and more hydration leads to skin barrier damage that allows for bacteria microflora imbalance. All of this is to say that it creates the perfect environment to create and/or worsen acne.
Mask-acne due to irritation from fabrics
N95 masks, surgical masks, and fabric masks are all made of different materials. Fabric masks are not regulated and can be made of different fabric/textile materials and different colored dyes. As opposed to clothing that one wears where there’s some breathing room, fabric masks are directly touching the skin for long periods of time. Also as you sneeze or breathe, this can lead to masks moving back and forth constantly on the face. For those with sensitive skin, this can lead to irritation over time, similar to wearing a very high underwear perhaps.
Mask-acne due to skin allergies from fabrics or detergents
The fabrics and dyes are all possible skin allergens as well creating an itchy rash that may look like eczema. Or the detergents people use to wash their masks may have fragrances or preservatives that may also trigger skin allergies. Or even makeup or skincare products which people have used for years, but now is subjected to being under the masks for hours may also be the source of skin allergies.
So what to do…
Firstly we should still keep wearing masks until the pandemic is over…
But until then if one has acne or folliculitis related to masks, the best thing to do is to wash your face before you put on the mask, avoid wearing makeup underneath the mask (you can wear it for eye makeup), put on sunscreen – ideally something with zinc oxide (zinc is an anti-inflammatory and anti-microbial agent, think baby barrier creams ie. Desitin), and then wash your face the moment you get home. If this does not due the trick, then use acne over the counter cleansers- look for ingredients that contain benzoyl peroxide or salicylic acid, and for my pregnant folks (use glycolic acid instead).
For irritant or allergic contact dermatitis due to mask-wearing, try to identify what is triggering the rash. Is it a specific fabric or dye? Is it a specific detergent? Avoid triggers if possible. Use over the counter hydrocortisone cream twice daily for up to a week to see if the itch or burning goes away. If all else fails, go to a dermatologist as we can help do a skin allergy test and prescribe stronger prescription strength creams to improve the rash.
Hopefully, with vaccines available now, the end is in sight and we can look forward to seeing each other faces again; not only on video conference calls. But until then, keep wearing those masks to protect yourself and others!
I am a board certified dermatologist based in Los Angeles. I am a comprehensive dermatologist caring for families. I love seeing children and adults. My youngest patient was 0 days old and her oldest was 110 years old. I have had psoriasis since the age of 8 and considered an expert in psoriasis and psoriasis treatments. I have lectured locally and nationally and published numerous papers on other topics such as skin manifestations of eczema, hidradenitis suppurativa, systemic lupus erythematous, granuloma annulare, microbiome, skin cancers, and more. My expertise includes knowledge in managing complex skin diseases. I am experienced with surgical treatment of skin cancers, as well as non-surgical methods to treat skin cancer and precancerous lesions. I run a full medical, cosmetic, and surgical dermatology practice. I am experienced with the use of complex dermatologic therapy, including biologic therapy, immunosuppressive medications, and phototherapy. I also treats fine lines and wrinkles non-surgically with combinations of botox, fillers, chemical peels, lasers, and radiofrequency. I perform minor surgeries such as excisions for cysts, lipomas, basal cell skin cancer, squamous cell skin cancers, and early stage melanoma. I am physician expert for Kopa for Psoriasis, part of Happify. I have been featured on podcasts and quoted in numerous online and print publications. I am honored to be named “Top Doctor” in Los Angeles magazine. In my free time, I volunteer for community events such as skin cancer screenings and at the local free clinics. I also teach internal medicine and dermatology residents at several academic centers. I try to do yoga every day and every year, I run a half-marathon at the Golden Gate Bridge.