The Age of Maskne

We are seeing more complications due to mandatory PPE as a result of Covid 19.  More acne breakouts, infections around the mouth area, contact dermatitis and even hair loss.  The use of PPE isn’t going away anytime soon so what can be done to mitigate the issues and prevent these occurrences?

Start by Making Sure Your PPE Mask Fits Comfortably

If not, it can lead to pressure indentations or breaks in the skin from repeated trauma. This can create an automatic open door to bacteria, viruses and even fungus leading to infection. If this happens, clean the area gently with a mild cleanser, let your skin dry completely and cover with a thin layer of an emollient such as Vaseline. If the skin behind your ears is irritated or even broken, consider investing in a few headbands with buttons (available on Amazon).

Maskne and Other Manifestations

Many have complained of increased breakouts due to the constant use of PPE. In dermatology this is referred to as acne mechanica.  This is seen a lot with sports that require the use of helmets such as football and hockey.  In the case of PPE, we’ll refer to it as “maskne.”  It occurs because the pilosebaceous unit is essentially blocked. It can get hot and humid under there creating a microenvironment bacteria and viruses thrive!  Not only are the pores inflamed but trauma is caused at the skin’s surface as well causing redness and pustules. The mask can make it a challenge to breathe but your skin needs to breathe as well.  Cleansing with a salicylic acid based cleanser (I prefer this over benzoyl peroxide) and using a tea tree oil based acne spot treatment twice a day (like Acne Buster) can help but the offending agent causing the maskne needs to be removed for a few hours. I know this is very hard for health care workers, bless them all.

A quick note about a condition that looks like acne but isn’t:  Miliaria a.k.a. prickly heat or sweat rash also gets worse with mask use.  It is due to blockage and inflammation of the eccrine sweat glands. The best way to treat this is to wash with cool water and a gentle cleanser like So Universally Clean then let skin air dry.  Calamine lotion or hydrocortisone are also helpful.

Contact Dermatitis

After maskne, the most complained about side effects is contact dermatitis.  Itching and rash under the mask is usually caused by being allergic to a component of the mask itself, whether it’s the woven or non-woven fabric, the elastic bands, metal clips or adhesives. If it’s a true allergic dermatitis, you may need patch testing to narrow down the offending agent. If treatment with an over the counter topical hydrocortisone ointment doesn’t help, call your doctor for a prescription.  Zyrtec or Benadryl can be used to relieve itching symptoms.  This is commonly seen at pressure points like the nasal bridge or the forehead for those wearing eye shields. To add insult to injury, if it’s not treated and allowed to heal, this is the sort of thing that can lead to post inflammatory hyperpigmentation which is even more difficult to treat.

Makeup

Wearing a lot of makeup under the mask can also be a problem. The makeup combined with sweat can, once again, create a breeding ground for bacteria. If possible, limit the use of foundation and opt for a light dusting of oil free mineral powder.

Nail Fungus

Another harbinger of infection or contact dermatitis on the face is acrylic nails. Often the seal between the natural nail and the acrylic tip can become a breeding ground for bacteria and fungus, especially since that area can retain moisture from repeated hand washing. Then we inadvertently spread this to our face.  Acrylic nails are made of methylmethacrylate which can cause skin sensitivities and contact dermatitis in areas distal to the hands. If you can’t go without, at least get a nail brush to clean the nails thoroughly.

Remember that fungal infections are treated differently than bacterial infections.  A simple way to keep fungus proliferation under control is to use an anti-dandruff shampoo to wash your face a few times a week.  You can also mix a little with your usual cleanser. The key ingredient to look for is ketoconazole which is a common and effective anti-fungal.

Cold Sores

With the increased stress that constant mask wearing is causing, we’re seeing more HSV-1 or herpes (cold sore) outbreaks. I recommend staying on a prophylactic dose as prevention if you are prone to them. During this crisis, I guarantee that our cortisol levels have been higher than normal and that effects our immune system so better to be safe and exercise prevention. A topical anti-viral can also be useful to speed up healing but I find that the oral treatment is far more effective, especially when you start it right at the outset.

Mask use will not be going away anytime soon.  Even before #Covid, healthcare works have been dealing with these mask induced skin conditions everyday.  But we had control over when to wear them and that, unfortunately, is no longer the case. So as we navigate these new waters, let’s try and minimize the maskne side effects as best we can.