One day going with one of my colleagues for the lunch during office hours, I noticed she felt very uncomfortable wearing a mask but at a time she denied taking off the mask until the food arrived. As soon as our order arrived, she took off her mask and I noticed a visible circle of red acne around her mouth. She was feeling very uncomfortable and I saw her feeling awkward because of her acne. So, I thought not to ask about that acne.

After a few days, I saw another young lady in the office with the same problem; acne around the mouth and she was repeatedly telling her friends that her acne is getting worse by wearing a mask after COVID-19. This made me think whether these acnes are associated with wearing masks or if it’s just a coincidence. Later on, I went through different articles on the Internet and got to discover that acne was maskne, which is significantly associated with wearing mask.

What is Maskne?

Technically Maskne is a type of ‘acne mechanica’ as simple as acne caused by the result of mechanical friction of mask against the skin. The mask we often wear exhibits friction against our skin resulting in inflammation and irritation of skin impacting skin pores ultimately resulting in acene and is also exacerbated by moisture absorption by mask from humidity and sweating. Maskne is mainly due to continuous textile skin adherence and friction, which creates a hot-humid environment within the mask modifying skin microbiota and sebum production. Maskne is mainly due to occlusion blocking facial pores and lack of enough oxygen needed for healthy skin resulting by the mask as a blockage. It happens when people wear tight/very tight masks for a longer period of time comparatively. Maskne includes several skin conditions like acne, rosacea, irritant contact dermatitis, atopic eczema, folliculitis, urticaria

It may be embarrassing for many individuals to have a significant circle of acene around the nose and mouth.

Causes of Maskne

Maskne may be acne breakout or just an irritation and itching around areas wearing mask.

1. Mechanical Force- Friction of mask irritates small hair follicles triggering inflammation and resulting in an acene. Maskne may be the result of clogged pores triggered by friction caused by the mask.
2. The humid and occlusive environment- When we breathe out and talk, the mask acts as a blockage to some level creating a humid and warm environment within it, which favors the natural growth of yeast, bacteria, and other skin flora (demodex- a natural skin flora a kind of mite).
3. The material of mask also can be allergic to some skin and can result in mask acene.

This friction and humid occlusive environment can result in acene (maskne), rosacea flareups, and other skin conditions like perioral dermatitis, atopic eczema, folliculitis, urticaria, and seborrheic eczema. Research showed that high temperature created due to the prolonged mask can affect the rate of sebum secretion and increased humidity can cause an increase in squalene in the skin resulting in maskne.

Common Symptoms

Mostly maskne can be found on the chin area (O-area) than on the cheeks and can appear as mild popular eruptions, with seborrhea and comedones along with irritation.

Management

1. As of now, wearing mask is essential for protecting yourself from COVID19 and for preventing transmission of COVID 19 even after you are fully vaccinated or completed the dose cycle of the vaccine against COVID19 so the only option is choosing the best quality of mask for maskne and COVID19.

Follow mask hygiene for preventing maskne

• Change your surgical mask every 4-6 hours at least.
• Choose a cotton cloth mask, if you prefer wearing a cloth mask (100% cotton)
• Regularly wash your cloth mask after you use it with hypoallergenic or fragrance-free detergent.
• Use a gentle cleanser for removing excess oil, sweat, and bacteria. Cleansers with alcohol and fragrance perfume should be avoided. The type of cleanser you need to use can depend on your maskne nature, if it is severe dermatologists recommend benzoyl peroxide and salicylic acid but always before using and applying any skin products it is necessary to have a consultation with your dermatologist.
• After cleansing, use oil-free or non-comedogenic moisturizer to keep skin hydrated and apply sunscreen for protection before 10-15 minutes of wearing a mask.
• Follow a regular healthy skincare routine; washing your face early in the morning, after taking off the mask, and before going to bed. Dermatologists recommend lukewarm water for washing their face and request people to gently dry faces with a clean towel.
• The use of skin lotion or moisturizer can minimize friction between skin and mask.
• Those who are experiencing irritation only due to friction caused by mask can use occlusive products like Vaseline.  
• Avoid putting heavy makeup on your face, mostly on mask-wearing area if you are experiencing symptoms of maskne.