Maskne Is the New Acne, and Here’s What Is Causing It – The New York Times

By | June 18, 2020
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Call it a sign of the times: The Korean skin-care brands Dr. Jart+ and Peach & Lily offer collections of “maskne essentials” on their websites. The patch purveyor Hero Cosmetics recently posted an entry about maskne on its blog. But don’t dismiss maskne — acne and irritation from wearing a mask — as just another portmanteau to market skin-care products.

“Oh, it’s a real thing,” said Dr. Mona Gohara, an associate clinical professor of dermatology at Yale School of Medicine. She herself has gotten maskne from her three layers of masks: a KN95 (similar to an N95) topped with a surgical mask to keep it clean, plus a face shield if she’s doing procedures.

“Oh my God, you can just feel things forming with the oil and sweat swishing around,” Dr. Gohara said.

Maskne — the most common kind of which is acne mechanica, a.k.a. the type of acne a football player may get where the helmet rubs — is also enough of a thing that the Covid-19 task force of the American Academy of Dermatology (A.A.D.) felt compelled to release advice on the subject.

Healthcare and other front-line workers are most at risk because their masks are tighter-fitting and they are wearing them longer. A research letter published in the Journal of the American Academy of Dermatology reported that at least 83 percent of health care workers in Hubei, China, suffered skin problems on the face. And anecdotally, doctors report an increase in acne flare-ups in people outside of health care as well.

“Conversations about acne have hit a record high in my practice and in my direct message box on Instagram,” Dr. Whitney Bowe, a dermatologist in Manhattan, wrote in an email. That’s because masks can worsen skin issues that already exist or cause new ones. Add in the summer heat and humidity and you’ve got a petri dish for breakouts.

1. Consider the type of mask you wear.

Only you can decide how you want to balance the weight of the mask material with the level of protection it will give you, but dermatologists suggest 100 percent cotton as a good compromise because it allows skin to breathe a bit. As the temperature rises and you sweat more, you’ll need to keep the mask clean.

“You need to treat it like underwear and wash it frequently,” said Dr. Candrice Heath, an assistant professor of dermatology at the Lewis Katz School of Medicine at Temple University. “You don’t want all of that oil and sweat and dirt to sit there and then you reapply it to your face constantly.”

2. Streamline your skin care routine.

Many of us use too many beauty products anyway, so consider mask wearing a good excuse to adopt the most basic skin care routine: a gentle non-soap cleanser and a mild, fragrance-free moisturizer.

“Fewer ingredients is better than more,” said Dr. S. Tyler Hollmig, the director of dermatologic surgery at the Dell Medical School at the University of Texas, who likes drugstore brands like Eucerin and CeraVe. The moisturizer does double duty here. Besides, well, moisturizing the skin, it can protect it from mask friction, à la a runner’s chafing cream.

Another reason for using fewer products: The mask will intensify product delivery to your skin. (You’ve seen this side effect of occlusion in action if you’ve ever, say, treated dry, cracked feet by applying Vaseline and wearing socks to bed.) But in the case of products with acids or retinols, which can be irritating, intensifying delivery is not likely to be a good thing.

Dr. Carrie Kovarik, an associate professor of dermatology at the University of Pennsylvania and a member of the A.A.D.’s Covid-19 task force, suggests using products with actives only at night. If you’ve never used a retinol — dermatologists charmingly call this “naïve skin” — Dr. Kovarik said that “now is not the time to try one.” If you’re a seasoned user, you may need to reduce your usage.

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3. Break up with makeup (at least temporarily).

If you put on makeup for a video call, consider taking it off when you go out. Dr. Heath gently chides patients who appear onscreen at tele-appointments wearing a full face of makeup.

“This is the time to really tone it down,” she said. For those who absolutely can’t break the habit, she suggests a tinted moisturizer with sunscreen.

If you sweat underneath your mask, Dr. Shari Marchbein, a dermatologist in New York, suggests using micellar water or a gentle cleanser to do a quick wash when you take it off. (Overwashing your face dries it out, tricking it into thinking it needs to produce more oil, which can give you more of the acne you’re trying to avoid.) Either apply moisturizer or, if it’s late enough in the day, whatever products you’d use at night, Dr. Marchbein said.

If you do end up with maskne, keep in mind that acne treatments can be irritating and you still need to contend with the continued irritation of the mask.

“You can just go gangbusters on regular acne,” Dr. Gohara said. “With maskne you have to be really careful.”

She recommends using an over-the-counter benzoyl peroxide treatment only on the spots, and starting with a 2.5 or 5 percent concentration, not 10 percent. If you use retinol, apply that product one night and the spot treatment the next.

The Coronavirus Outbreak

  • Frequently Asked Questions and Advice

    Updated June 16, 2020

    • I’ve heard about a treatment called dexamethasone. Does it work?

      The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.

    • What is pandemic paid leave?

      The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.

    • Does asymptomatic transmission of Covid-19 happen?

      So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.

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      Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.

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      A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.

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      The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.

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      Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.

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      Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

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    • Should I wear a mask?

      The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.

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If you have black or brown skin and develop hyperpigmentation from the acne, Dr. Heath recommends a topical with glycolic acid, which can treat both the blemishes and the darkening of the skin. She cautions against long-term use of a skin lightening agent without the advice of a dermatologist.

Dr. Gohara, who like Dr. Heath specializes in treating skin of color, reminds patients with hyperpigmentation to wear sunscreen even indoors, because blue light from devices can make the problem worse.

If what’s on your face looks like more of a rash or “makes you want to scratch your face off,” as Dr. Gohara put it, it’s possible your issue isn’t actually acne. You may have contact dermatitis, which she sees patients get from metal or rubber parts of masks, and some fabrics (which, when washed, may release formaldehyde, an irritant) and dyes.

Hydrocortisone cream can help, though you’ll want to see a dermatologist for proper diagnosis and treatment. “Dab deliberately, don’t slather,” Dr. Gohara said. That’s because hydrocortisone cream can, “stoke the acne fire,” she said, though the mechanism is unclear. (Yes, this seems counterintuitive because cortisone shots are still the gold standard for shrinking a pimple, but it’s true.)

If you’ve tried all of the above and your acne persists, you may want to look at two other causes of acne: stress and diet. Dr. Bowe wrote: “If I see a tender cyst on the chin, there’s no way to say whether it popped up because of the mask, because of that sleepless night or because of those comfort foods they reached for over the weekend.”

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You can’t buy stress release in a jar, but there is increasing evidence, including a large epidemiological study published last week in JAMA Dermatology, that chocolate and other high-glycemic (sugary) foods and dairy cause adult acne.

You could, as Dr. Bowe advises, avoid processed snacks and bring on the coconut or macadamia nut milks. If that’s too far to go, take comfort that a mask at least hides the problem.

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