Mask-Related Acne (Maskne): Causes, Prevention and Treatment

Maskne, or 'Mask acne', is a new term used to describe acne or rashes that develop from wearing a face mask for long periods. The problem has increased markedly since the COVID-19 period, when many people had to wear masks all day. Maskne is correctly known as Acne Mechanica, acne caused by friction and trapped moisture.

Causes of Maskne

Moisture builds up inside the mask when it is worn for long periods; friction from the mask causes Follicular occlusion, a situation that favours the growth of Propionibacterium acnes bacteria, which cause acne; chemicals in the mask material may irritate the skin; carbon dioxide (CO2) trapped inside the mask changes the skin's pH; sweating and bacteria; and increased heat under the mask.

Areas Where Maskne Occurs

Maskne usually appears where the mask touches the skin most: the chin (lower face), the cheeks (both sides of the face), the nose and the area around the mouth. Skin in these areas is more congested than elsewhere and has many Sebaceous glands, so the risk of acne is higher.

Other Problems That Can Follow Mask Wearing

Besides acne, wearing a mask for long periods may cause other skin problems, such as: allergic rashes from friction (Contact dermatitis); dry, itchy, irritated skin; dark marks on the cheeks and chin (Post-inflammatory hyperpigmentation); and flare-ups of Rosacea (facial redness), which is often triggered by the heat and moisture trapped under the mask.

Preventing Maskne

Choose multi-layered cloth masks (Cloth masks) that breathe better, such as cotton blends, rather than Synthetic materials that may cause irritation; wash your face clean before putting on a mask, and wash again right after taking it off; use a Gentle cleanser suitable for acne-prone skin; avoid heavy creams because they add moisture inside the mask; avoid wearing Makeup on skin that will be under the mask, and if necessary use Oil-free, Non-comedogenic cosmetics; and take breaks from wearing the mask periodically if possible.

A Skincare Routine That Helps Reduce Maskne

Wash your face twice a day with a Gentle cleanser suited to your skin type; use a mild Toner or Astringent to reduce oiliness; use a Lightweight moisturizer that is Non-comedogenic; apply a daytime cream containing Sunscreen SPF 30+; use an Acne treatment containing Salicylic acid (BHA) or Benzoyl peroxide (if your skin tolerates it); and Retinol or Adapalene (Differin) help reduce the build-up of Dead skin cells, although Retinol may irritate the skin.

Treating Maskne

If acne does not clear even after self-care, please see a dermatologist. The doctor may prescribe topical medicines such as Topical antibiotics, Topical retinoids, or Oral antibiotics for people with severe acne. Laser or Chemical peeling treatment can sometimes help reduce the dark marks left after acne (Post-inflammatory marks). At Siam Dermatology in Samut Prakan and Bangkok, our doctors have experience treating Maskne and related skin problems.

References: (1) Sah SK (2021). Maskne: A new pandemic challenge. J Cosmet Dermatol 20(3):655-656. (2) Zuo Y, et al. (2021). Skin reactions to N95 respirators and other face coverings. J Allergy Clin Immunol 147(2):426-434. (3) Dao H, et al. (2020). Acne mechanica. In: Goldsmith LA, et al. eds. Fitzpatrick's Dermatology in General Medicine. 8th ed. (4) Janssen JM, et al. (2013). An outbreak of acne mechanica from occupational exposures related to the use of airway management equipment. Arch Dermatol 149(10):1196-1198.