Mask Related Irritation & Acne

This is a topic I have been wanting to talk about for a while. With face masks in widespread use due to this extraordinary year, many of us are experiencing mask related irritation and/or "maskne" (mask related acne). As masks won't be going anywhere anytime soon it's a topic worth covering. Some us may wear masks our complete shift at work such as healthcare workers like myself, factory workers, grocery store workers, clerks at gas stations, day care employees or any essentially deemed service. That's forty hours a week in a mask just at work. Add on a mask for personal use to go to the grocery store or complete other errands and you're looking at a lot of time in an occlusive covering.

At first I thought I was doing alright with masks. I had no issues for a few weeks. I thought it wasn't going to happen to me. Granted I don't have acne prone skin anymore due to my drying skin (thank you aging), good skincare routine and my hormones have balanced out for now. The first symptom I noticed was bumps on my chin and lower cheeks. This was mostly along my jawline. I finally realized this was potentially the dreaded maskne showing up. Maskne or Acne Mechanica is caused by friction, heat and a reduction in circulating air (or no air in the case of workers wearing N95s). Occlusion of hair follicles with a build up of excess oil and dirt plus sweating can help cause an overgrowth in the acne bacteria. Makeup such as foundation can also add to the problem and clog pores. When you're wearing a mask you'll notice your warm breath creates a hot moist environment under your mask which is the perfect environment for this bacteria to thrive.

Some of the things that can help maskne are benzoyl peroxide cleanser/treatment (2.5-5%) and/or salicylic acid cleanser/treatment (cleanser under 0.5%, toner 2% or below). If you use both consider separating the salicylic acid from the benzoyl peroxide in different routines. They can both be drying on the skin. A salicylic acid (BHA) containing toner is also helpful and is my personal preference. The toners have a higher concentration of BHAs so I can't use them daily because I'm not super oily to begin with. More of a 2x a week use for me. If you're super oily or acne prone before masks you may get away with more often. A salicylic acid wash is more gentle than a toner as it has a lower percentage and washes off so that may be the best choice for some. Now is also the perfect time to wear a pimple patch in the daytime if you need it. Nothing hides it better than a mask. Plus the patch will reduce friction on the affected area. I like iS Clinical Cleansing Complex as my favorite BHA containing cleanser though I would like to try The Inkey List Salicylic Acid Toner. Toner wise I love Paula's Choice Daily Pore-Refining Treatment which has 2% BHA. I love it's a lightweight texture and non-sticky feel compared to the traditional 2% BHA toner they have. I tend to put this more on my jawline and areas that need it versus a blanket covering because that fits my skin needs right now. Adding in a BHA toner again in the problem areas a few times a week really solved that maskne for me. Keep in mind I'm not acne prone so while that worked for me, the amount you use in your routine may need to be played with depending on your skin type.

Ingredients that have antibacterial and/or healing properties are great. Besides benzoyl peroxide and BHAs, think propolis, honey & silver. Mask wise my favorites are Fresh Creme Ancienne Nourishing Honey Mask & I'm From Honey Mask. These two are soothing and hydrating to give your skin a nice treat. iUNIK Propolis Vitamin Synergy Serum & By Wishtrend Polyphenols in Propolis 15% Ampoule are great serum options if you're looking for propolis though there are many options. Propolis helps with acne and also helps reduce oil production as a bonus.

There's a new product By Wishtrend Quad Active Boosting Essence that looks promising with propolis and willow bark (natural BHA). I might be grabbing it soon just to play with it. The entire Omorovicza Silver Saviour Collection is great but the Mask & Tonic are my favorites. The Silver Saviour collection has silver and BHAs. The mask once a week is a nice treat. I know many who swear by this mask. Manuka honey is really great due to the nutrient dense profile. I prefer Manuka over regular honey. My favorite Manuka honey containing moisturizer is Allies of Skin Molecular Multi-Nutrient Day Cream. This is also perfect for the summer weather right now, it's not heavy at all, just nourishing.

I also really like pre/probiotics to help balance the skin both as a supplement and topically. I like The Inkey List Multi-Biotic Moisturizer and lately I'm obsessed with the new Acaderma Equilibria Toner. Its light and slippery texture is perfection. You can use it as a hydrating toner or as an essence. Green tea is also great at reducing oil production and balancing the skin without being drying. Green tea also has antibacterial and astringent properties making it great for acne. Isntree Green Tea Toner is a great cheap green tea based toner. Plus it's fermented so you get probiotic benefits as well.

Another ingredient becoming more popular is hypochlorous acid (HOCL). You may have seen it in the Tower 28 SOS Spray or Clinisoothe+ Skin Purifier. HOCL is naturally made in the body by white blood cells to help fight infection. It's great for fighting the bacteria that causes acne and clogged pores (it breaks down bacterial cell walls), speeds up wound healing and might help with inflammation in conditions like eczema and psoriasis. I love it as a hand sanitizing spray, it's actually more gentle than alcohol based hand sanitizers. I also use it on my LED Omnilux mask to disinfect it, and many love to spray HOCL on cloth masks to reduce the bacteria on the mask thus helping with maskne. Some also use HOCL as a facial mist in their skincare routine to help with bacteria and maskne. I find it a little drying myself and haven't found it helps with my rosacea per se, but I know many like it for acne or eczema.

Mask irritation is caused from the physical friction/rubbing in combination with the warm, moist environment inside the mask. This warm moist environment alone causes skin irritation and sensitivity. Add in some friction/rubbing and you may see raw, red, itchy or just general unhappy and irritated skin. Your skin may feel more sensitive than usual without the obvious signs like redness. Sometimes you may notice stinging when applying products that shouldn't sting. That's sensitivity. Mask irritation manages to be my main issue more than maskne. Anti-inflammatory, soothing, gentle, hydrating and barrier repairing ingredients and products are going to be vital for mask irritation. Even though you may be experiencing maskne as well, now is not the time to go crazy on your skin. Less is more with irritation & sensitivity as well as any acne. If you're experiencing major sensitivity you could try a 1% hydrocortisone cream twice a day on certain spots but that should really be a short lived thing while you implement skincare routine changes and contact your primary care doctor or dermatologist.

A gentle non-drying cleanser is key. Think low pH in the 5-6.5 range for water based gels or try a creamy based soothing cleanser. Some of my favorite non-drying, gentle, low pH gels are Krave Matcha Hemp Hydrating Cleanser, Allies of Skin Molecular Silk Amino Hydrating Cleanser & Dr Sam's Flawless Cleanser. The new Laneige Cream Skin Milk Oil Cleanser is quite nice. It's got a light milky soothing feel. SENTE Daily Soothing Cleanser is another really nice gentle soothing creamy based cleanser. I like these two for creamy based as they're not too rich and heavy texture wise. For night cleansing with oils I love Deviant Cleansing Concentrate, The Inkey List Oat Cleansing Balm & The Ordinary Squalane Cleanser. All of these remove makeup and emulsify so you don't have to use a flannel to remove if your skin is irritated. I also like all of these cleansers as they're without any added fragrance or essential oils. Low to no fragrance can help when your skin is irritated.

There are lots of calming ingredients out there. Think soothing like cica, arnica, chamomile, aloe, licorice, allantoin, panthenol, calendula & oats. I also like Dragon's Blood for its healing and anti-inflammatory properties and don't forget niacinamide which helps with barrier repair. Just don't over do the niacinamide as too much can cause irritation (think under 10% as a target range). Any kind of hydrating product with these will be a nice addition. I know azelaic acid is helpful for rosacea, I have yet to really try it long term with my current irritation so I can't speak yet as to whether or not I think it helps for mask irritation. I did just start a product with 10% azelaic acid last week so we shall see if it helps. I really like products that help with barrier repair such as natural moisturizing factors, cholesterol & ceramides. Stratia Liquid Gold was my first true barrier repair product I fell massively in love with. It still saves me every year. Kate Somerville Ceramides + Omegas Serum is a lovely lighter textured version (it has been renamed and revamped). Bioderma Matricium is one of my all time favorite skin saviors. It has elements found naturally in the skin that helps with regeneration. It's amazing on irritated skin for repair. It's not accessible in the US but there are a few online places that ship here (caretobeauty, carethy, frenchcosmeticsforless). Le Mieux Iso-Cell Recovery Solution is also similar in concept. It's got amino acids and minerals to hydrate and calm stressed skin.

I like a few light hydrating layers to soothe and hydrate when my skin is stressed out. YOU Skincare Moisture Replenishing Essence has a really nice light slippery hydrating texture. It's got soothing and healing ingredients like aloe, thanakha, green tea, nettle, cucumber, horsetail, panthenol, yucca and multiple forms of hyaluronic acid. Two of my favorite hydrating serums are NIOD Multi-Molecular Hyaluronic Complex & Medik8 Hydr8 B5 Intense which has additional natural moisturizing factors. Moisturizer plays a big part in helping your skin with it's mask related irritation. It adds an extra barrier between your skin and the mask to protect against friction. The mask friction rubs the moisture out of the top layer of your skin. I get this a lot on my cheeks and chin from my surgical masks at work. This makes me really raw and irritated in those areas. The Ordinary Natural Moisturizing Factors + HA is great. It's cheap, fragrance free and helps replenish the skin. It's light enough to not feel too heavy or greasy for those with oilier skin and you can use it during the day as needed. I love to reapply this all day on my nose, cheeks and chin. It also makes a great hand cream. Some other really great soothing and repairing creams are Indeed Labs 10balm & La Roche-Posay Cicaplast Baume B5 (Cicaplast is the heaviest of these three).

*Of note if you're wearing an N95 mask using a moisturizer is not the best idea as it can mess with a seal. I've seen a few nurses wearing tegaderm on the bridge of their nose to help with breakdown. I know some doctors/dermatologists have made great posts for those wearing N95 masks experiencing more severe issues than the general public. This post was mainly for the general public though most basic ideas covered in this post will apply to my fellow nurses and other providers as well. Just not moisturizer under your mask.

At night I really have been using my repairing and heavier creams. Normally I would go lighter in the summer but the light ones are not cutting it for me right now. My favorite ultimate all time healing overnight cream is Biologique Recherche Creme Masque Vernix. Ridiculously expensive, yes. But it heals my skin overnight. My skin loves oils and my other two magical overnight healers are May Lindstrom The Blue Cocoon & VOTARY Super Boost Night Drops. In general when you're experiencing irritation staying away from added fragrance and essential oils is helpful but there are some essential oils like blue tansy in The Blue Cocoon that I find helpful for soothing my skin when it's irritated. CBD is a trendy skincare ingredient right now but I do find it soothing. VOTARY's oil hands down is the best version of it I've tried. I'm going through it like crazy right now. I haven't touched another oil for nights in two weeks and I've noticed some improvement.

I think right now is the time to remember to be nice to your skin, don't go crazy when you have new issues like maskne or mask irritation. Go to a simple, gentler routine until you get it under control. And always see a professional if you can't manage these new symptoms from face masks at home. I find my nose has been almost my biggest irritated area lately. I actually had to stop applying retinol in the nose to chin area which has really helped. I'm still using retinol on my neck and the majority of my face, I only use it in the nose/chin area right now once a week. Usually on a weekend when I'm at home not wearing a mask giving my skin a chance to breathe. I've cut down my acid use and cut out really strong ones. I have to admit I haven't been able to use Biologique Recherche P50 right now due to my mask irritation. I'm only using really mild acid toners and have cut them down to twice a week which seems to be working for me. I also had to cut down or back on my higher percentage ascorbic acid use. That helped with my irritation as well. Cutting back or down on actives when you're irritated sometimes just has to happen. Don't forget to still wear sunscreen, a mask does not stop your need to wear it. You may find a mineral one helpful if you're irritated right now. Make sure you clean your mask frequently either by spraying/wiping it down with isopropyl alcohol or washing it if it's cloth. This will help with maskne. I prefer a cotton based cloth mask when I'm not at work as it's not only more hygienic but it is less irritating than a rougher textured or synthetic fabric. I'm sure I left out all kinds of really great soothing products but this was just to be more of an overview. Have you been dealing with maskne or mask irritation? What is helping you?

Update 7/9/22:

I have found my Omnilux LED mask immensely helpful at reducing irritation. I've been using it for over a year now. As I must continue to wear masks daily in the workplace (it's been over 2 years now) I find my irritation continues to grow and be more constant. The Omnilux has been really great. Full review HERE.