Great. I’ve been working on improving and taking care of my skin for years, and almost suddenly – after only a couple of hours of wearing a mask (or two) – I developed the so-called “maskne” on unusual spots. Those serene spots that hadn’t been invaded by any acne or acnegenic conditions for years. And I’m talking about 2 or 3 years and above here!
To give you some context here, I’m not working a 9-to-5 job that’d require daily office visits. So, I’d wear a mask only when I have to go out for something of significant importance. And yet these acnegenic reactions keep on surprising me in how they’re taking place on my skin. So, kudos to those who’s got to work not from home (almost) every day. Maybe you’re one of these dedicated people; so kudos to you, too!
Without any further due, let’s get super comprehensive on maskne!
We’re going to talk about:
Knowing different types of acne lesions might help us deal with maskne
I thought those bumps over my face, red or not, are all just acnes. No types, no different names, except that they come in different sizes. Some look red and inflamed, while the others are not so much.
Little did I know that there are various types of acne lesions and even acne-like medical conditions.
Knowing (although only briefly) about different types of acne lesions could help you with sorting out countless information that isn’t even related to your circumstances at the moment. Make a knowledgeable and more accurate guess and conclusion. This will allow you to determine the best course of action to be taken. In the end of this article, I hope you’d be able to answer these questions:
- What would best describe the maskne on my skin?
- What would the probable causes be?
- How has the maskne problem been created by wearing a mask?
- Is there anything that I can do to minimize or even avoid these undesirable maskne problems? What is it? Or what are they?
- What can I do to improve this inevitable maskne situation?
Comedonal acne
The most common type, acne vulgaris, is caused by excessive production of sebum caused by over-stimulation of the sebaceous gland, by larger amounts of sex hormones produced in teenagers.
Now. Like it or not, our likelihood to develop acne is largely affected by 2 hereditary factors: retention hyperkeratosis and oiliness. These two factors are also the very causes for comedonal acne. Yes, the most common form of acne, which could develop into their various more advanced forms in weeks.
Retention hyperkeratosis is a hereditary condition where dry, dead skin cells are undesirably retained and would later obstruct the follicles. The amount of sebum produced by our skin is hereditary. When I traced back my family “acne history”, I found out that my paternal grandmother used to suffer from those huge, inflamed acnes in her teens. So did (most of?) her kids in their younger years. And so did my mom. And yes, we’ve got relatively oily skins.
Try combine these two major factors together.
What you’d get is a small impaction called a microcomedo, which is a mixture of dead cell buildup, bacteria, sebum’s fatty acids, as well as other cellular debris. These invisible (unless microscopic examination of skin tissues were conducted) tiny comedones will later develop into any acne lesion (Mark Lees, 2012).
When the cellular debris keep building up in the bottom of the follicles and the sebum keeps being secreted and thus coating these fed up areas of the skin, the microcomedones will develop into visible acne lesions on the visible surface of our skin. In general, they could be either inflammatory or noninflammatory acne lesions. Inflammatory acne lesions are the ones that we usually describe as “acne” or ‘pimple” – yep, those red and inflamed ones. That being said, the noninflammatory acne lesions are the ones that are not red, nor inflamed. Examples include blackheads (open comedones) and whiteheads (closed comedones).
There’s an exception, though.
That is, when the primary bacterium that causes acne vulgaris – Propionibacterium acnes (P. acnes) – is being taken into account. Unlike open comedones, closed comedones have very small pore openings, thus preventing oxygen from penetrating the affected follicle. Which is the perfect condition for the P. acnes to grow, since these specific bacteria are anaerobic, i.e. incapable of surviving in the presence of oxygen. The inevitable multiplication of P. acnes then gives an unexpected chance to closed comedones to develop into inflamed acne lesions. These easily-recognizable small bumps are often associated with the use of comedogenic cosmetics (Mark Lees, 2012).
No, we’re not even done talking about closed comedones!
When there is an excessive amount of bacteria, the impaction becomes larger and larger, thus tearing the follicle wall’s inside. Now it’s time for the immune system to send the white blood cells to come into rescue. Arriving via the blood vessels, these white blood cells create a purposefully red, inflamed lesion. This particular lesion could become either papule (no pus) or pustule (enough white blood cells, rising to the surface just waiting to burst out). Although papules never come to a “head”, they are what we normally describe as sore bump, since they are deeper in the skin, hence affecting nerve endings more than pustule. And they could form into cluster within the stimulated area. Good news is that sometimes a papule would just magically disappear, which means the immune battle won the battle against the infection.
Be careful though, similar to papule, there is a type of lesion that’s called nodule – which is deeper and feels more solid and more painful compared to papule. There are also cysts, which are very large and pustular; these are deep infections caused by a deep, massive invasion of white blood cells (Mark Lees, 2012).
Inflammatory acne
“Overnight zits” are great examples of inflammatory acnes. This type of acne is caused by inflammation inside the follicle. Various factors that could cause this kind of inflammation include overstimulating skin care products, causing the follicle walls to swell and block the flow of oxygen to the follicle’s bottom part. As you would imagine, this creates a perfect environment for the growth of our nemesis, P. acnes. They live from our sebum, cause inflammation, creating the possibility for the sudden existence of papules and pustules without the development of comedones.
Just like comedogenic reaction, this inflammatory, acnegenic reaction can also be caused by other inflammation. Yep, it’s not all about the overstimulating skin care and cosmetic products. These might include follicle irritations, over-treatment, e.g. too much exposure to peeling and drying ingredients, and so on. The bottom line is that these inflammatory acnegenic reactions do create sudden flares. Which is a totally different mechanism to the gradual buildup of cells and debris that make the primary sign of comedogenic reaction (Mark Lees, 2012).
Other things to consider
In my experience, there’s this urgency of holistic approach when we’re dealing with acnes – to some extent. Of course, hormones play an undeniably huge role here. Especially when they are associated with stages or phases in life, such as puberty, pregnancy, menopause, etc. But there are other things that we’d need to consider when we’re talking about this age-old conundrum, e.g. medication, stress, lifestyle, diet, environment, hygiene, and so on, most of which could have a direct or indirect link to our hormones.
Maskne Causes and Solutions
Now that we know a little bit about acne, the next puzzle to solve would be the relationship between acne and mask. How does wearing a mask contribute to the birth of maskne on our skin? And how do we improve this tricky situation? Is there any solution to this, at all?
1
Heat, humidity and the reduced oxygen supply and circulation
I believe most of us were not so used to wearing a mask for hours at a time. This might the one of the biggest changes we experience during this pandemic era – and our skin feels it, too. And painfully so.
Now when you heard the words “fabric breathability”, you’d probably make a direct connection between the reduced quantity of available oxygen and the mask being in direct contact with the skin, since the breathability of a fabric can be defined as a degree to which a fabric permits both moisture and air to pass and circulate through it.
Surprise, surprise, it’s not about the mask being a barrier between our facial skin and the precious oxygen! Is this really a thing? I personally don’t think so. From what I know, our hair follicles, which are located deeper in the skin, get their oxygen supply by the blood capillaries. Moreover, in contrary to what some of us might think of this, the pulmonologist Jonathan Parsons, MD assures us that behind the mask, we’re getting all the oxygen we need, and the carbon dioxide levels do not increase – all of which had been proven by medical professionals displaying their excellent oxygen levels while trying on different masks and even wearing multiple masks at once. He further explains that anxiety and certain psychological conditions might have come into play in this case.
As I will explain more clearly very soon, these maskne occurrences can be traced back to the depleting oxygen levels. However, the mechanism goes beyond the speculation on how a mask might be a barrier between our skin surface and oxygen.
Instead, the actual culprit here is an increase in the exclusive environment’s humidity and heat caused by wearing a mask for hours. Note that heat and moisture can accumulate in the microenvironment between our facial skin and a mask that was made of a set of poorly breathable fabrics. Imagine that moisture and warmth being created whilst you’re talking with someone with your mask on.
In his book, Dr. Mark Lees explains that heat causes the skin to swell slightly, whereas humidity causes tremendous swelling of the outer epidermis. From here, it could be assumed that this swelling could cause enough additional pressure to the follicles, thus exacerbating the existing conditions. Which, honestly, really is a big deal for every clog-prone skin owner all around the world.
This additional pressure on a follicle could further obstruct the oxygen pathway, thus limiting the oxygen supply to the follicle even more.
Do you still remember when we were talking about P. acnes? Well, I haven’t told you that these anaerobic bacteria are constantly existing in our follicles in small amounts. The main thing that’s been keeping them from multiplying is the oxygen that’s constantly aerating each open follicle.
Now that the oxygen access to the follicle becomes even narrower, the aeration gets more restricted. The bacteria, as a consequence, can multiple so extravagantly. Clearly, we’ve got ourselves a perfect recipe for acne, or in this case, maskne flare-up here.
Solutions:
We cannot not wear a mask when we’re outside, for sure. However, to minimize the chance of developing maskne we can make some adjustments to our own skin care routine.
- One way to do this is by eliminating all products that are too hydrating. But how do we know which ones are too hydrating and which ones are fine? This could be a tricky task since in general, well-hydration has been an essential factor in skin health. However, what we’re facing right here, right now, is quite a special case. We’re changing a habit here, from zero mask to wearing two or more masks every day. In other words, additional humidity. The most obvious way to avoid too-hydrating products is to avoid the products that say “super hydrating” on their labels. You can also find out all the hydrating ingredients in the ingredients list. We usually call them humectants. Some of the humectants that are used in the natural and organic skincare world include glycerin and honey extract. An ingredient with the highest percentage will be the first one on the list, and vice versa. With this information, you can make a guess on whether or not a certain product would be too hydrating. Note, though, that guessing this way wouldn’t be reliable, especially if you’ve never been involved in skincare formulation. That is, too many factors to be considered here. The core idea is, most of the cases, to tone down your skin hydration by adjusting your skin care regime. Because nowadays, you know, we’ve got additional humidity by wearing a mask.
- Avoid comedogenic products, especially if your skin is clog-prone. Inspect all emollient ingredients in the product, since many emollients have been known to be comedogenic. You can also substitute your day cream that you with lighter product, such as lotion or sprayed milky emulsion.
- I know for some of you, what I’m gonna suggest next is not going to be an easy one. That is, don’t wear too much makeup, or even don’t wear any. You might be able to find yourself a noncomedogenic makeup range. Take into consideration, though, many spreading agents and pigments in cosmetics are known to be comedogenic and sometimes very comedogenic. Lovely Ladies, I think it’s now a perfect time to give your lovely bare face a go. Because, come on, everyone’s face is hidden behind their mask nowadays, anyway!
2
Prolonged friction and shear between the human skin and the mask’s fabrics
This point is actually still significantly affected by the previous point, i.e. humidity. A study by Vilhena and Ramalho in human skin tribology shows that moisture can accelerate and promote the formation of pressure ulcers. This was shown by an increase in the coefficient of friction between the skin and fabrics by a factor of more than two in the majority of cases, as the skin goes from dry to wet.
When Vaseline was used in the experiment, the coefficient of friction initially decreased due to the lubricant properties of it. However, later on, the coefficient increases over the baseline due to the increased moisturization by the occlusion. Lubricants such as Vaseline and glycerin hydrate the skin surface by reducing the rate of TEWL (Transepidermal Water Loss). This will consequently increase the coefficient of friction induced by the slow and prolonged hydrating effect (Nach et al., 1981).
As stated by Vilhena and Ramalho, prolonged pressures on body parts, as well as friction and shear between the human skin and textiles, according to the Braden Scale for Predicting Pressure Ulcer Risk, can possibly lead to superficial abrasions and tissue deformation.
As the layers of skin are deformed or compressed between the bone and hard surface, our blood is squeezed out of the underlying tissue. Again, this causes the blood circulation to be obstructed, which could cause a lack of oxygen, leading to tissue death. From here, the skin starts to break down, thus developing a pressure ulcer.
As you would have noticed, the surface of a mask does make a direct contact with some areas of the skin surface. Depending on what type of mask you’re wearing, the mask would seem relatively tighter or looser on different spots. Similarly, some masks would feel more tightly-fitting compared to the others. And if you think about it, different sizes and shapes of our faces could also be determining factors here. Well, at least to some degree. In addition, different fabrics display different levels of breathability (the degree to which certain fabric allows air and moisture to pass through it), which is determined by the composition of fibers and how tightly they are woven together.
In the case of wearing a mask for hours, the effect of pressure and friction might probably not be as devastating as it is with pressure ulcers. The ones, which often develop on the skin of bed-ridden patients in the hospitals. However, although it’s only a combination of almost insignificant pressure and friction between the mask and the skin, we can’t take this combo out of the “maskne” equation. Especially when we’re talking about thinner, sensitive, and/or clog-prone skins here. The types which would more likely be affected by even the smallest triggers.
Solutions:
The following suggestions could also be the solutions for the first point above (Heat, humidity and the reduced oxygen supply and circulation):
- First and foremost, find yourself the most suitable, functional reusable fabric masks for your current situation. You can check out this WHO guide on how to choose and wear masks. In one of the informative videos there, they say the three-layered fabric mask’s inner layer, which comes in direct contact with your face, should be a hydrophilic material, so it could absorb the droplets from your exhaled breath. Cotton is an example of this material. Fortunately, studies in skin tribology also found out that the fabrics with a greater hydrophilic tendency display the lowest friction coefficient. Which actually makes a perfect sense, since highly hydrophilic fabrics absorb water droplets. This would minimize the moisture trap in the mask environment, which in turn lowers the friction coefficient. This means that the correct design of these mask types also favors our skin health by default. No dilemma here, which is always a good sign. Depending on how tightly woven it is, in general, 100% cotton fabric also possesses good breathability. This means air and moisture naturally and easily pass through it. Do your own research (read and/or ask trusted source) on the best mask’s inner-layer fabric, which would satisfy all our criteria for functionality and skin health here.
- Change your mask with a clean, washed one when it begins to feel too humid or wet. Depending on what you do through the day, change your mask every (approximately) 3 – 4 hours. Also change it when it is stained and looks dirty.
- Wash your reusable fabric masks in warm water, with an enough amount of hypoallergenic detergent-based fabrics wash. Sometimes the skin gets irritated by the residue of “harsher” chemicals in different forms of washing liquid. Especially when the skin has been relatively irritable or sensitive to start with.
3
Over-cleansing
During this pandemic era, it seems like our house is the only safe place from the virus. Entering the house after a long day at work or maybe only an hour of grocery shopping now needs a meticulous set of “disinfecting” procedure. Which would only be completed by going into a shower in the end of it. Maybe someone accidentally lets go of a sneeze in the cafeteria not far enough from where you’re sitting. And all you could think of is finishing off your meal. And proceeding to wash your face right away, somewhere else.
Keeping our skin as dirt- and pollution-free as possible is, without a doubt, important. Especially remembering this era we are currently in, where hygiene has become more of a top priority than ever.
It needs to be made clear though, that acne is not solely caused by dirt. There is so much more to it, such as the many variables, the both direct and indirect links. And so on. In fact, excessive cleaning can aggravate acne. More specifically, the detergents in facial cleansers can aggravate acne when the skin is too-frequently exposed to these ingredients.
In his book, Mark Lees also says that washing the face three times and more, daily, can easily cause enough irritation to precipitate an inflammatory acne aggravation. Furthermore, it could possibly damage the skin barrier function, which would then cause redness and dehydration issues. The skin barrier function and hydration are both essential to the maintenance of healthy skin. And compromising the two could be damaging to the skin, making it more susceptible to external stressors. Hence higher chance of maskne development due to the prolonged mask use nowadays.
Solutions:
This also heavily depends on the “personality” of your skin.
- In his book, Mark Lees suggests clients who over-cleanse to cleanse only 2 or at most 3 times a day. His another suggestion is to use a more aggressive cleanser only once a day. That, and then use gentler cleanser for any additional cleansings.
- Personally, as a person with oily, dehydrated and relatively clog-prone, as well as relatively sensitive skin, I always have 2 types of cleanser where I live. A cleanser with a mild detergent in it and also water-rinsable cream cleanser. Pre-pandemic, I’d adjust when to use which, depending on whether or not I’m going out on any particular day. However, anyone who would have to go out everyday during this pandemic era, for your general safety, I would suggest you to use the stronger, detergent-based cleanser in the evening, so that all the oil-based dirt and grimes (as well as “the enveloped virus”) could easily be dissolved and removed from the surface of your skin. Especially when you’re back from all activities outside your house. You can then apply and rinse your milder cleanser in the morning before going out for the day.
4
Neglecting daily care
Funnily enough, what’s happening to me is really the opposite of point number 3 above. You see, I stay inside the house almost every day in a month. To be more descriptive, approximately 6 months have passed since the virus and all, and so far, I never went out for more than 4 times in a month.
Being myself enough, I take a shower only when I need to (when coming back from somewhere outside the house). Also when I feel like I have to (when my scalp begins to itch from days of not taking shower). Consequently, still being myself here, I do my skin care routine relatively seldomly. That is, after each shower and when I feel or sometimes when I think I need to do that already). Now compare it to how I normally do my skin care routine before this outbreak. Yep. Twice a day of face washing, followed by toner and facial oil application.
Reflecting back on how my skin feels, looks and behave back then and now (after only about 6 months of this downward change), I would readily encourage you not to go down the same road, and stick to the “twice-a-day” routine, instead. Even though you’re not going out as much as you would in the pre-outbreak life.
I’ve been having combination skin for as long as I can remember, with a tendency of being dehydrated and also oily in some areas, including the T-zone area.
Pre-pandemic, my skin felt at its best than ever, but now it often feels both dehydrated and oily in some areas. To top it off, it feels a bit flaky, and sometimes the pores appears a bit larger than usual.
So. What’s probably happening here is that, for every time that I skip my cleansing and toning routine, the surface dirt and debris get their chance to just stick around. In the meanwhile, the dead skin cells don’t get their chance to be shed. This might not be as huge of a problem for the relatively-non-problematic-skin owners. But if your skin is anything like mine, the burden of retention hyperkeratosis tendency (please check out the part “Comedonal Acne” above if you’ve got no idea or need some reminder about what it is) will come knocking on the door when you choose to ignore the basic skin care routine such as cleansing and toner application. In addition to all that, at least in my case, skipping the twice-a-day skin care routine also means skipping the application of skin treatment, such as facial oil, moisturizer, night cream, etc.
Now imagine having this situation and top it all off with wearing a mask. All debris of unshed dead skin cells, dirt, grease and sebum, get lightly pushed back from wearing a mask. Now top it off with the humid and warm environment also created by it. We’ve now completed all the requirements for impaction, i.e. swelling by heat and humidity (see point 1 above for more details), light force and friction, as well as debris-clogged skin – all of which the perfect ingredients for today’s infamous maskne.
So please. Please keep up with your daily twice-a-day skin care routine for your own good.
Solutions:
- Obviously, not skipping your twice-a-day skin care routine is the best advice that I can share with you (says a person with a high tendency to not taking care of her own skin diligently while spending almost all the time inside the house and drifting further away from the civilization during the pandemic period).
- Various approaches in treating acne would largely depend on the type of acne itself. But, in general, the common mantra could be “treat and soothe”. In the natural and organic skincare world, tea tree oil is known for its anti-acne properties. At the same concentration, (the harsher) benzoyl peroxide and tea tree oil effectively reduce the number of both inflamed and non-inflamed open and closed comedones. So, you could try applying an acne spot treatment that contains tea tree oil in it. You can also apply soothing skin care product as one of your night treatments. Or you can apply it every alternate evening if you’re worried about applying too many skin care products on your irritable skin at once. Oats, chamomile (both Roman and German) and calendula extracts are three of the most well-known and well-researched anti-inflammatory ingredients in the natural and organic skincare world. Take some time to apply a soothing skin care product containing one or more of these ingredients. This would be beneficial in treating irritated skin and inflammatory acne, which could include your maskne, especially in this case.
- If you’re anything like me during the pandemic (a “cave person” or more accurately a “house dweller”), and as a consequence, going out of the house for no more than 4 times in a month, make some changes in your skin care routine. Make it more fun. Re-organize and/or redecorate where you put your skincare products on or in. Maybe throw in some colorful and inspiring things in creative ways. Make the skin care routine less mundane, and ultimately, more fun! Hmm, this could be a great idea for a blog post, don’t you think? Please let me know in the comments section below!
5
Stress
Are you stressing out from the current situation? Just hang on there, you’ re not alone at all. It’s completely normal to feel this way in this pandemic period. It’s a different battle for everyone. But I can imagine it being a constant, every-day-battle or maybe a rather dilemma for everyone who’s got to go out of their house to earn a living.
In his book, Mark Lees says that many acne sufferers, estheticians and dermatologists have noticed acne flare-ups when the patient is under stress. He further explains that as a reaction to stress, brain manufactures a hormone that causes the adrenal gland to make even more hormones. This, as a consequence, causes an abundance of oil to be produced. That’s why so many people do suffer from premenstrual breakouts – the reaction is very similar under stress. Since additional stress is imposed on us by both PMS and the current pandemic, the rise of maskne should be understandable, too, don’t you think?
Solution:
- No doubt, the whole thing about this most recent virus has put a significant additional pressure on us. In times like this, though, what we can and would better do is to focus on what we can control. Live a healthier life. Eat healthier, satisfy your body with all those vitamins and supplements. Do enough workout, take enough sunbath. In public places, wear proper protective equipment for every situation, keep your hands properly cleaned, avoid touching your face. Then, stop or, at least, minimize worrying about the things you can’t control. And try to unwind and have fun every time you can – of course, in the safe environment.
So there I have included all the things you would need to know about the all-intrusive maskne. I hope this post would help you with your maskne problem. Have you had successful stories combating this pesky maskne? You are more than welcome to share any tips that might be very useful to anyone here. And if you’re still struggling with this problem, you’re not alone! Please do share you concerns and any tiny and huge improvements here in the comments section.
Love and best wishes,
Ella
Easy 2-ingredients Cleansing Oil for Your Sensitive Skin
