Reading: What Masking Up is Doing to Your Face

“Maskne. It’s like a new diagnosis,” says New York dermatologist Dr. Ellen Marmur. “People are coming into the office and asking for help with it all the time now.”

“Maskne” is the term people are now using to describe acne and other skin problems that are erupting due to our new habit of wearing face masks to prevent the spread of COVID-19. I got an extreme case of “maskne” in mid-August. The morning I was supposed to drive with my son to North Carolina for his return to college, I woke up and the tip of my nose was swollen, red, and incredibly painful. In fact, it looked exactly like Rudolph’s from the 1964 Red-Nosed Reindeer classic. I was mortified, hauled myself to urgent care, was diagnosed with cellulitis of the face, and prescribed a 10-day regimen of Bactrim, an antibiotic. The condition subsided, thankfully, in a day. 

Not everyone is getting cellulitis, though a friend’s husband also experienced this skin infection. Many people, however, are getting pimples, rosacea, enlarged pores, and increased blackheads, among other skin issues, in the area around their noses, mouths and chins that are covered by masks. This is because the wearing of masks — no matter which kind, paper or cloth — is messing with the microbiome of facial skin, Marmur explains.

KEEP THINGS SIMPLE & KEEP THINGS CLEAN

Marmur, a skin care, skin cancer, and dermatological surgeon, and Los Angeles–based aesthetician to the stars Melanie Simon, both agree that to prevent maskne, you need to keep your skin clean and your skin care routine simple. Reduce the amount of actual product — from skin care to make up — you’re using, and adapt a gentle practice of skin cleansing, toning and moisturizing. You also need to practice scrupulous oral hygiene, clean or change your masks at least daily, and change your washcloths and pillow covers at least weekly. These steps (and what they further advise) works for for all skin types and colors; they can keep the microbiome healthy, and your skin glowing.

The microbiome is the group of microorganisms including bacteria, fungi, and viruses that live on our skin and keep it protected. Just as we hear more about the balance of gut health for overall well-being, keeping the microbiome of your skin intact is crucial for our skin’s integrity, Marmur notes. She explains that our facial skin likes to be acidic, but wearing masks screws up the Ph and physical balance of the microbiome, thanks to everything from creating friction and scraping off the top layer of the skin, to acting as a barrier and trapping the oral bacteria from our mouths on top of our skin, rather than allowing it to be released into the air. 

Ewwwwww, gross.

Gross is right, because without taking steps for oral, topical, and home hygiene, a cystic pimple can turn into a staph infection, notes Simon. 

“Staph is everywhere. We are making it easy for staph to get inside the skin,” observes Simon, referring to how a mask can trap the staphylococcus bacteria that naturally sits on top of your skin. If you pick your skin, or have any break in the tissue, wearing a mask can cause bacteria to enter the epidermis and create an infection.  

The temptation might be to overclean your skin, but both Marmur and Simon warn against that as well as overzealous exfoliation. These more aggressive steps lead to further disturbing the microbiome, and harsh exfoliation can actually create crevices or tiny holes in the skin. Both say that occasional gentle exfoliation is ok.

“I would not go down the acne aisle in the drugstore,” Marmur says. “Stay away from benzoyl peroxide. Use a gentle makeup remover, a cleanser such as SkinFix Foaming Oil Cleanser, and keep it as simple as you can. Less is more. Treat your skin like you’d treat a baby’s skin.”

TRADITIONAL SKIN CARE AND BEYOND

Marmur, who has her own MMSkincare collection of LED-light activated skin-care products and LED light ring you can use at home, also says to brush and floss your teeth diligently, after every meal. This reduces the amount of bacteria in your breath that gets trapped by the mask and then rests on your face. Marmur also suggests swabbing the inside of your nostrils with a Mupirocin, a prescription nasal antibiotic. If a female client is having pernicious skin problems as a result of mask-wearing, Marmur sometimes prescribes Spironolactone, traditionally a high blood pressure medication and diuretic, which additionally reduces testosterone and blocks our oil-glands’ production of fatty acids. The coming winter weather will cause dry skin, Marmur notes, and she advises rotating your skin care products and topical prescriptions to those that are more hydrating.

Simon, who developed the ZIIP nanocurrent and microcurrent home device that stimulates the skin’s own healing ability and production of collagen and elastin, has a similar philosophy for mask-related skin care. She is a huge fan of Bioderma Sébium H2O Micellar Water. She suggests using it to clean your face once daily, preferably as soon as you know you are home for the day or night, and to do a final water rinse. Simon abhors hot water and advises using a lukewarm temperature. She also recommends changing your skin care routine if you are in the habit of layering different products in the morning. Some products such as a vitamin C serum can actually be used later in the day, when you know you’re not going out again with a mask. For those of us who live in climates that will become cold soon, Simon suggests using the richer moisturizer you use at night during the day instead. 

For exfoliating, Simon likes the Tatcha Rice Polish Classic, a non-abrasive exfoliating foaming cleanser from Japan with Hadasei-3, a combination of green tea, rice and algae, among other ingredients. After application, she advises using the Tatcha Violet-C Brightening Serum with 20% Vitamin C and 10% Alpha Hydroxy Acid.  She also likes the P50 1970 Exfoliating Lotion from French brand Biologique Recherche. This is available by prescription from dermatologists or aestheticians. For irritated skin, Simon loves the soothing properties of Egyptian Magic skin balm, which boasts ingredients including olive oil, royal jelly, beeswax and bee pollen. 

FRONTLINE WORKERS STILL SUFFER THE MOST

Of course, few experience the harsh maskne of frontline healthcare workers who endure both physical and topical damage to their skin from the hours and days of mask-wearing. Medical professionals are experiencing pressure injuries on nose bridges, cheeks, chins and the area behind the ears — all the points where the necessary N95 masks are tight, in addition to topical skin damage from mask friction, explains Dr. Manisha Singal, the Chief Medical Officer and Board Member of BridgePoint Healthcare in Washington DC, who runs that hospital’s Intensive Care Unit. Singal developed the Aethera Beauty collection of skin care that relies heavily on natural botanicals including hemp oil or CBD, and she personally swears by the Everyday Botanical Brightening Concentrate, which comes in two formulations, one of which contains CBD. 

“Aethera’s topical skincare collection is formulated with nontoxic active botanicals known to nourish the skin with natural vitamins, omega and amino fatty acids, and oils to promote skin health,” Singal explains. “When applied to inflamed skin, these natural compounds have a soothing effect on inflamed skin.” 

INTERNATIONAL BEAUTY MIX TO THE RESCUE

As for me, my combination skin’s doing great, thank you. French pharmacy brand, La Roche Posay, which is available in the US, has saved the day. I use the Effaclar range for oily skin, notably the cleansing gel, and I alternate with Effaclar micro-exfoliating astringent toner and the clarifying solution. I then apply a vitamin C serum from TruSkin, available on Amazon. For sunscreen, the EltaMD UV Clear sunscreen with niacinamide is the only facial sunscreen that doesn’t burn my eyes out. My day moisturizer is currently La Roche Posay’s Hydraphase Intense Light with hyaluronic acid, and I adore the Toleriane Ultra Night lotion with shea butter, glycerin and antioxidants. For little dry bumps or former zit spots, I dab on Switzerland’s Weleda Skin Food Original Ultra-Rich Cream with emollient ingredients including sunflower seed oil, sweet almond oil beeswax and botanicals such as rosemary leaf and calendula flower extracts. Based on Marmur’s and Simon’s suggestions, I will cut back on the exfoliating products. But my skin has not looked or felt better in ages.

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