Just when we thought we’d seen it all when it comes to pimple triggers, the COVID-19 pandemic came along and introduced us all to a new word: Maskne. This condition, which refers to acne spurred on by mask wearing now has an official definition, according to a recently released study that narrowed it down to acne with an onset or change in severity within weeks of regular face mask-wearing over the lower face. [1] Researchers refer to this area as the “O-zone.” If you’re grappling with it, know you’re not alone. Dermatologists like Jerry Tan, M.D., adjunct professor of dermatology at the University of Western Ontario and an Acne Store advisory board member, have been flooded with pleas from patients for help in tackling the condition. What kind of mask should I pick to avoid acne? Can wearing makeup make things worse? How do I stop maskne once it starts? Dr. Tan has the answers.

Q: Articles about maskne are all over the Internet— is it a real thing?

A: It definitely seems that way. A lot of people are experiencing breakouts after wearing face coverings, but in some cases it's not actually acne. For some, masks are triggering inflammation of the hair follicles, known as folliculitis, which might require an antibacterial or an anti-yeast medication to treat. Or it could even be rosacea—a skin condition characterized by redness of the cheeks that patients often mistake for acne.

You might be able to tell what you’re really dealing by taking a closer look: Acne is characterized by the presence of little blocked pores called comedones. White ones are called closed comedones; the ones that have a central gray opening are called open comedones or blackheads. If there’s no presence of comedones, the lesions themselves are likely not acne. Also, acne is ongoing, so different clusters of breakouts will come and go. Conditions like folliculitis tend to hit all at once while rosacea will also have the tell-tale feature of redness of the central face. 

Q: What causes maskne?

Number one, wearing a mask increases the heat and temperature on the skin in that area, which cases irritation. Number two, it increases humidity. You also have to consider the ongoing circulation of bacteria and yeast from your nose and your mouth inside the mask. And then there’s the pressure and friction caused by mask. It’s really a perfect storm for clogging pores.

Q: Any tips for picking a good mask that doesn’t cause maskne?

The most important thing is to choose masks that have a very soft fabric; cotton if possible, since that’s the most breathable. If you prefer a surgical mask, that should work too since it likely has multiple plies of fabric that are softer and smooth on the inside. You also want it to fit well: It shouldn’t dig in or rub too aggressively against the skin but you want it snug enough to be effective in protecting you from airborne particles. I also suggest giving yourself periodic breaks when you’re properly distanced from others. Just take it down for a few minutes to give your skin a rest.

Q: How often should you switch out your mask?

Ideally, daily. I would hope you have a whole volleyball team of masks you can rotate on and off your face. Each player has 24 hours to perform and then goes off to the wash—then another mask goes up to play. Making sure your mask is fresh and clean is a surefire way to stop maskne caused by built up bacteria and sweat.

"A lot of people are experiencing breakouts after wearing face coverings, but in some cases it's not actually acne."

Q: Give it to us straight: Should you wear makeup when wearing a mask?

Having it on your skin under the mask is probably not going to help the situation. My suggestion is to skip foundation and stick to eye makeup, like eyeshadow and eyeliner. And do continue to wear sun protection—just avoid tinted sunscreens as they discolor the mask and can make them appear dirty.

Q: How do I prevent maskne?

As soon as you come home, remove your mask and cleanse your face. The primary focus is trying to be as gentle as possible, because your skin is already going to be under assault by the mask as well as what’s happening underneath it. Avoid soaps, which break down the skin barrier, and instead use a very gentle pH balanced cleanser or bar with synthetic ingredients—meaning not lye, the ingredient in a true soap. Then apply a good moisturizer to help repair and restore your skin’s protective barrier. To do that, I would look for products that contain ceramides, hyaluronic acid, glycerin, or dimethicone. Many products fit this description, so choose one that you like, make sure it doesn't cause any problems with your skin, and use it daily.

Another change to make: If your acne care products are a little drying or irritating, use them at night only. This prevents more irritation during the day when you’re wearing your mask. And, finally, for daytime, putting on sunblock is absolutely fine. Just make sure that you use one you’ve had good results with in the past. You don’t want to risk trying a new formula now and wind up having a bad reaction.

References:
[1]: Diagnostic and management considerations for “maskne” in the era of COVID-19