What it is and how best to treat it

The world over, acne is one of the most common reasons for a visit to the dermatologist’s office. However, since the start of the global COVID-19 pandemic, dermatologists have seen a significant increase in the number of patients seeking their guidance on acne related matters, often in patients who have never suffered from acne before. There has also been an increase in the number of returning patients, i.e. patients who had suffered from acne, but had it well under control and others who, although currently already under treatment for acne, are still experiencing a deterioration in the condition.

With all of the above attributed by dermatologists to the wearing of face masks, Dr Mathobela, a leading specialist dermatologist and OXY’s resident skincare expert, provides some suggestions on not only how to combat and help control this new household word, ‘maskne’, but also to help us understand exactly why this is happening.

Why the wearing of face masks can cause ‘maskne’?
It’s important to revisit the pathogenesis of acne to help understand the occurrence of ‘maskne’. Acne occurs in genetically predisposed individuals due the following factors:

• Follicular hyperkeratinisation: This leads to follicle occlusion and the formation of comedones.
• Increased oil production or hyperseborrhea: Secondary to hormonal fluctuations, environmental and immunological factors.
• Modification of the microbiota: A complex community of bacteria, viruses, and fungal organisms that reside on the skin and have important roles, especially P. acnes that activate the immune system, leading to inflammation.
• Inflammation: Subclinical before acne lesion appears.
• Environmental factors: Known to worsen or influence the response to treatment, with face masks falling under environmental factors.

How face masks influence acne
It can be broken down into mechanical, climatic and other factors, explained in more detail below.

Mechanical factors: causing acne mechanica
Masks, especially ill-fitting ones, can lead to rubbing and irritation. This can result in the thickening of the epidermis leading to hyperkeratosis and the blockage of pores. Further, a disturbed skin barrier can cause an increase in water loss and penetration by pathogens, resulting in inflammation. Reduced water content in the skin can lead to a dry, flaky and irritated face. Modification of the lipid film on the skin surface, together with changes of cutaneous microbiome, can further exacerbate dryness and inflammation.

Climatic factors:
The build-up of heat and humidity, as a result of talking and breathing behind one’s mask, can trigger inflammatory acne flare ups due to this heat and humidity promoting bacterial overgrowth.

Other factors:
The wearing of dirty masks from repeat use without washing, as well as wearing occlusive moisturisers and make up, can also lead to either the formation of new acne lesions or the exacerbation of existing ones.

However, not all lesions associated with wearing masks are ‘acne’
It is important to note though that not all lesions associated with wearing masks are ‘acne’. One can also present with irritant dermatitis and/ or allergic contact dermatitis (red, flaky skin often associated with burning or itching) without comedones. Another non-acne side effect of mask wearing includes other forms of eczema-seborrheic dermatitis, rosacea-red papules and pustules (mainly on the curved parts of the face), perioral dermatitis-red papules and pustules (mainly around the mouth, nasal openings and around the eyes) and folliculitis-infection of the hair follicles.

So, exactly how does one treat and/ or minimise the chance of ‘maskne’?
Dr Mathobela shares some useful tips below:
• Change or wash your mask daily! A 100% cotton mask is advised for masks that will be worn more than once.
• Take mask breaks during the day, whenever possible and safe to do so.
• When washing one’s face, use gentle cleansers with a pH of 5.5, rather than soaps.
• Cleanse your face at least twice a day.
• Moisturise in the morning and at night to support a healthy skin barrier (restore or improve) and to protect the skin from friction. Avoid perfumed moisturisers that can irritate the skin.
• Should you need to use make up, make use of non-comedogenic products and only apply a very thin layer.
• Make use of sunscreen with a minimum SPF of 30.
• Do not introduce any new skin routines, unless advised to do so by a doctor.
• Front shop treatments such as OXY 5 or OXY 10 could also help. Always seek medical advice if you are not sure of what you are dealing with.
• Visit your dermatologist for medical treatment should the problem persist.