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June 26, 2022

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‘Maskne’ sufferer? Vancouver dermatologist offers advice

Doctor says mask-fueled acne real, treatable

By , Columbian staff writer
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We’ve learned a lot about masks in the past couple years: which are the most comfortable, which can survive washing and which won’t fog up our glasses. Masks are literal lifesavers during the pandemic and, even as the omicron surge eases, we’ll still need masks for certain activities.

As we know, it can get hot and damp underneath a mask, and it can rub uncomfortably against the skin. These are perfect conditions for “maskne,” a nonmedical term describing acne in the area covered by a mask.

Maskne may not be a scientific term, but it is a real condition. Dermatologists have even developed clinical criteria: acne appearing or worsening under a mask after six weeks of mask use.

If you’re seeing pimples pop up under your mask, don’t stop wearing one, said Dr. Michele Thompson, a dermatologist and dermatopathologist who has her own clinic in Vancouver.

“COVID is worse than acne,” she said. “This is not to minimize the impact of acne because acne’s effects on quality of life and health can be significant. However, we have excellent treatment for acne. This may not be the case for COVID or its complications.”

What causes maskne? Simply put, a mask alters the environment for the skin underneath right down to the microbial level. Moisture from warm breath creates humidity. Repeated friction creates inflammation, which causes increased production of oil. Known as sebum, this protective layer of oil on our skin mixes with dead skin cells and bacteria, blocking pores, which are openings for hair follicles. The blocked pores, or comedones, can become inflamed, resulting in pimples, whiteheads or cysts.

Fortunately, several remedies alleviate mask-caused acne. Thompson’s first recommendation is adapalene, found under the brand name Differin. She said it’s “the gentlest out of the retinoid options and the only one that’s over the counter.” She said it changes the metabolism of the skin, unblocking follicles and reducing sebum production. Adapalene can be drying, though, so it’s best used in small amounts every night or every other night, Thompson said. It should not be applied under a mask, she added.

Thompson also recommended face washes and lotions containing salicylic acid, which helps to minimize sebum and the accumulation of dead skin cells. Like adapalene, it can be irritating, so Thompson said to look for a mild, 1 to 2 percent salicylic acid face wash or lotion.

Thompson mentioned several other ingredients to search for when choosing facial cleansers to help with maskne:

  • Benzoyl peroxide has antibacterial properties and can improve the skin’s microbiome, but choose products with a 4 to 5 percent solution to avoid irritation, Thompson said.
  • Zinc-based washes also have antibacterial properties but are less drying than benzoyl peroxide.
  • Face washes with hyaluronic acid and niacinamide can help regulate sebum production while keeping skin moist.
  • For very sensitive or eczema-prone skin, Thompson recommended using Cetaphil Gentle Skin Cleanser and then applying a moisturizer with dimethicone under the mask.

Whatever product you buy, read the fine print.

“Don’t look at the front. Don’t look at the pretty label. Look at the back and find the active ingredients,” Thompson said.

If over-the-counter remedies don’t make a difference right away, don’t give up. Thompson said it can take eight to 12 weeks to see an improvement. Even a single acne lesion can take a month to heal, but it shouldn’t take longer, she said.

If your skin doesn’t improve after eight to 12 weeks, see a dermatologist, because your acne might require prescription medicine or it might be something more serious.

If you’re concerned about developing maskne, you can incorporate acne-control products into your skin-care routine.

If you need to wear a mask for long periods of time, as Thompson herself does, she recommended giving yourself regular “mask breaks” of 15 minutes every two to four hours, as long as you can do so safely with adequate social distance.

If you need to wear a mask for more than eight hours a day, you might consider skipping makeup and sunscreen in the area underneath the mask. Above all, be gentle with your skin.

“Most of these acne treatments are drying and irritating so they have to be used with care. Avoid over-washing or using aggressive skin regimens that could worsen the acne outbreak,” Thompson said. “I often see acne patients whose acne has flared much worse because of the things they’re trying to do to treat it. When it comes to washing, less is more, especially when you have inflamed skin and might be using one of these medications.”

Some websites advise wearing cloth masks to prevent or alleviate maskne, but Thompson said those sites don’t necessarily reflect the most recent information. She said there’s “not a consensus on which masks provide both maximum protection and maximum skin health,” though a hybrid cloth-synthetic mask is being researched.

Whether you have maskne or not, you should follow the Centers for Disease Control and Prevention’s masking guidelines, which rate N95 masks as the most protective, followed by KN95 masks or well-fitting disposable surgical masks. Loosely woven cloth masks offer the least protection but are better than no mask at all.

“With our current contagious omicron variant, we need to be vigilant and use the most protective mask that we can,” Thompson said. “We are all tired, but the situation will not last forever.”


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