Maskne: What Is It and How Do You Prevent It?

If the stress of COVID-19 didn’t make your skin break out, the mask you’ve been wearing might.

Some are calling this “maskne,” describing the kind of acne caused by wearing a face covering that traps oil, sweat, and bacteria beneath it. Before the pandemic, the condition—officially known as acne mechanica—was mostly seen in athletes and workers who wear helmets and chin straps, says Sara Perkins, MD, a Yale Medicine dermatologist. When a mask rubs against the skin, it can irritate small hair follicles, which triggers inflammation and generates acne.

“It’s common in lacrosse and football players, and also in police officers, who wear vests with heavy padding,” she says. “Anything that covers the skin, especially if there is heat and sweating involved, can cause acne—not just on the face, but also on the back and shoulders. Right now, I am hearing from many patients whose acne is flaring up from wearing masks.”

Surgical masks and N95 respirators can trap a good amount of moisture and humidity and lead to skin problems, but even cloth masks can be irritating to the skin, notes Kathleen Suozzi, MD, a Yale Medicine dermatologic surgeon. “In addition to the acne caused from friction, we are seeing periorificial dermatitis, a rash on the rosacea spectrum that occurs around the mouth and nose,” she says.

Given that mask-wearing is a key component in preventing the spread of COVID-19, we can expect wearing them to be part of our daily lives for a while. Drs. Perkins and Suozzi offer the following tips to prevent or minimize mask-related skin issues.

Avoid products that contain fragrances or too many chemicals, Dr. Suozzi advises. “The humidity created under the mask concentrates those ingredients around your face, making them more likely to cause irritation,” she explains. “A really gentle, fragrance-free cleanser is a good place to start. Aggressive exfoliation and topical acids will make your skin too sensitive.”

It’s also important to be gentle when you cleanse your skin after sweating underneath your mask. “Your natural inclination may be to excessively clean your face if it’s broken out, but if your skin is already irritated, that will only make it worse,” Dr. Perkins explains. “Use a mild cleanser and moisturizer.”

If you are wearing a mask, consider skipping makeup, as it’s just one more thing that can clog your pores, Dr. Suozzi says. “In fact, this pandemic is an opportunity to give your skin a break from over-processing, and reset it,” she adds.

Instead, stick to a soothing moisturizer, and wait 15 to 30 minutes to let the product soak into the skin before putting on your mask, Dr. Suozzi advises.

And if you are also applying sunscreen (which can be included in your moisturizer), Dr. Suozzi recommends sticking with one that is mineral-based (zinc oxide or titanium dioxide) rather than chemical-based, which could further irritate your skin beneath the mask. 

While health care workers need to wear medical-grade masks, the general public—and especially those who are struggling with skin eruptions—may do best with washable, cotton masks, doctors say.

“A breathable cotton mask that you launder regularly is ideal,” Dr. Perkins says. “If you need to wear your mask for long periods of time but can take a break from it for a little while, you can put it in a paper bag to let it dry out in between uses during the day.”

For mild cases of maskne, over-the-counter facial washes and topical treatments that contain benzoyl peroxide or salicylic acid may help. “If you have more sensitive or dry skin, try one with salicylic first,” Dr. Perkins suggests.

But for maskne cases that don’t easily resolve, Dr. Suozzi recommends calling a dermatologist. “It could be a quick telehealth appointment where you’d receive a prescription for medication to get it under control,” she says.  

Typical acne medications often don’t work on maskne, she adds. “For acne mechanica, retinoid medications such as Retin-A are often effective, but they can also cause skin irritation, which can be worsened by wearing a mask,” Dr. Suozzi says. “But there are products for acne/rosacea-type conditions that can be prescribed or even found over the counter.”

Maybe masks aren’t the source of your skin issues right now. “There are many reasons your skin may not be at its best during a global pandemic,” Dr. Perkins says. “We know that a diet high in sugar and processed foods can worsen acne in someone who is predisposed to it. We also know that stress affects hormone levels, which can make acne and other conditions flare up.”

Plus, sleeping and eating patterns may be different right now for many people. “If you don’t have to be up at 7 a.m., maybe you are staying up later or eating things you normally wouldn’t,” she adds.

And if the maskne sticks around for a little while, there is one saving grace: The mask will hide it.

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