Maskne: the perfect storm for acne caused by face masks/coverings and accelerated by stress.

At Park Avenue Skin Care, not a day goes by without at least one patient complaining about new acne breakouts, "maskne,” whether they usually have acne or not. Most people (I hope!) wear masks or other face coverings at some time in the course of the day. That’s critically important in the control of COVID-19 and, in my opinion as a physician, is THE most essential part in the widespread efforts to help reduce, control and ultimately eliminate the spread of covid. But it’s not good for most people’s skin. Masks/face coverings cause significant acne breakouts in people who have or are prone to acne, or have oily, acne prone or even combination skin. 

In this guide, you’ll learn the following about Maskne:

• Maskne is caused by the constant friction that is happening between your skin and the mask. Your mask, for many hours a day, is rubbing against your face and trapping oil, dirt, and makeup. Essentially, it’s creating a warm, moist environment for extra skin oils to proliferate and for bacteria to become trapped. 
• Stress is another major cause of your Maskne.
• Preventing Maskne is doable and requires your oil and water to be balanced. Exfoliation is key to keeping oil at bay.
• Treating Maskne can be done by cleansing & toning, chemical exfoliation, and spot-treating.

The Truth About Maskne?

I have chosen to name acne from masks and other facial coverings “maskne” to denote the syndrome of acne caused or exacerbated by the wearing of masks or other face coverings. Before I explain to you how to prevent and/or treat “maskne,” I’ll tell you what’s going on and why it’s happening.

Very simply, all acne is caused by three main factors: excess oil, clogging dead cells, and bacteria called Corynibacteria. But the first factor, excess oil, is the root cause of acne, meaning you must have excess oil to have acne. But, a not well known but very important fourth factor—actually, very important cause of acne—is anything that touches your face repeatedly. This means rubbing or simply touching your skin for minutes or hours every day. All drive, promote and cause breakouts. 

Anything that repetitively rubs your skin induces it to make more cells, thicken, and increase the dead layer, creating more acne-causing, clogging dead cells.

How Masks are Causing Acne

But masks and facial coverings unfortunately are in a league of their own because they operate at a hugely greater level in driving acne for several reasons. First, they rub your facial skin much harder than any of the other facial contactants mentioned above. They affect a much larger area of your facial skin than the other contactants, and they are touching and rubbing your facial skin for much longer periods of time: 10, 20, 30 minutes to hours for most people (for me, 7-8 hours a day). Then there’s the repetitive motion of your skin under the mask from talking, smiling, making involuntary expressions, even chewing gum. That repetitive motion with the pressure exerted on the skin by a proper fitting mask is unique to masks and other effective facial coverings. 

But now it gets worse. Take off your mask after wearing it for 10 or 20 minutes and look at the inside. See some makeup? See hues of tan or gray, just like the discoloration on your toner/astringent pad you use after you wash your face? That’s oil and dirt that you just removed from your skin. Can you imagine taking that soiled pad and then rubbing all the gunk back onto your skin? Well, that’s what your mask is doing. That’s really throwing fuel on the fire that's causing breakouts.

How many times a day do you clean the inside of your mask? How many times a day do you change your mask to a new or cleaned or washed mask. Have you ever cleaned your mask? Do you at least change to a fresh mask every day? It goes on and on.

How Stress Comes into Play

The one external force that is MOST responsible for increasing oil production (the main driver of ALL acne breakouts) in your skin is stress. Your body has an anti-stress department to help you deal with stress. It’s called your adrenal gland, which under provocation by stress produces and secretes the anti-stress hormone called cortisol, which enters the bloodstream and is delivered everywhere in your body to help fight stress! But here’s the problem—whenever your adrenal gland discharges stress reducing cortisol, a tiny bit of male hormone leaks out with the cortisol, and the androgens also get delivered everywhere in your body, including the oil glands in your skin. Remember I said the root cause of acne is oil? Sadly, androgens (male hormones) are the single trigger that makes everyone’s oil glands produce more oil. 

Stress Causes Acne. Period. 

For most people, the past 4 months have been the most stressful times of their entire lives. The pandemic has stressfully impacted every part of our lives, and stress attacks us from every direction. And one more stressor that has the potential to be more acnegenic than anything else I’ve discussed.

Given that stress causes acne, now put stress-induced increased oil together with rubbing from masks/coverings, and an exponential increase in acne results. I don’t have to remind anyone that distressingly eruptive, unsightly, painful annoying acne significantly all contributes to an erosion of our sense of well-being, which too often causes an erosion of our self-esteem and self-confidence. This all comes together as another (very impactful) stressor and source of additional stress.

I have just described a de facto positive feedback system that by definition has the ability, if unchecked, to take on a life of its own and increase endlessly. Covid is the cause of pervasive stress, which increases acne and which synergizes with protective face masks and coverings in causing acne. And your acne itself causes you stress, which increases excess oil-fueled additional acne, and on and on it goes with maskne. The maskne itself becomes epidemic as it takes on a life of its own.

4 Factors that Drive Acne

Before I tell you how to prevent and treat maskne, let's summarize an overview of the 4 factors that drive acne.

1. Oil, the root cause of acne: increased by many mechanisms  

2. Clogging dead cells and debris: increased by mask/face coverings

3. Repetitive rubbing/touchings: increased by mask/face coverings

4. The acne bacteria (corynebacterium): unaffected

7 Proven Steps to Preventing Maskne

Effective prevention of course is the priority. Let's go through each relevant causal factor above.

1. Oil and Water Balance

Decreasing the production of oil—the root cause of all acne, including maskne—is essential. Daily use of a gentle but effective glycolic exfoliant, like the BeautyRx Tetrafoliant 8% Peel Solution has been demonstrated to (amongst other helpful effects for acne) significantly decrease the production of oil and is the only topical product I am aware of that can decrease oil. In addition to bringing your facial oil and water back into balance, the reduction of skin oil simply reduces acne. Period.

2. Oral Medications

Good thing is, there are also oral treatments to reduce oil and thereby help prevent maskne—including hormonal contraceptives, spironolactone, and Accutane—but in my experience, to prevent and control maskne, they are rarely needed. 

3. Exfoliation

The second causal factor, clogging dead cells and debris, can also easily be reduced, which then helps to prevent maskne. A chemical exfoliant such as a glycolic serum will decrease oil and will exfoliate away the clogging dead cells. 

4. Cleanse & Tone

A cleanser and toner designed for oily/acne-prone skin prevents the buildup of the excess oil that contributes to the clogging factor that causes maskne. 

5. Less Makeup

Wearing less face makeup (or no face makeup under your mask) prevents the buildup of debris that contributes to the maskne-causing clogging factor. 

6. Clean Your Mask

Clean your mask daily. Or if you can, change to a fresh mask every day, and make sure you wash and tone your face every morning before putting on your cleaned or fresh mask.

7. No More Touching

The third causal factor in maskne, repetitive rubbing/touching of the skin by mask/face coverings is a little trickier. In order for the mask/face covering to be effective, it needs to fit properly. This means complete contact of the mask/covering to ensure the best possible seal. So, to mitigate the effect of the rubbing, use an oil-free moisturizer as a lubricant to decrease the friction from a properly fitting mask/covering rubbing your skin due to normal movement during talking, smiling, etc.  

Treating Maskne the Dermatologist Way 

The treatment of “maskne” has many similarities to treatment of conventional facial acne, but as always, early treatment is best. As an overview, you need a daily routine consisting of the use of a cleanser, toner, glycolic exfoliant, spot treatment, and moisturizer.

If you simply cleanse and tone twice a day, every day, that in and of itself can cause a 30-40% improvement in your acne.

Cleanse

First, remove oil, dirt, makeup, and debris that clogs your pores. But make sure you’re using the right kind of cleanser for your skin type. Most people with acne suffer from excess oil in their T-zone. However, you may have combination skin where you have excess oil in your T-zone and dry patches on your cheeks. Make sure you choose a cleanser that works for your skin type to make sure you’re getting the best cleanse possible. Take my skin type quiz here to find out.

Tone

Toners (astringents) are very important to use after your cleanser to synergize with the cleanser in removing residual oil, dirt, makeup, etc. Pat your face dry after cleansing. Put your toner on a makeup pad (not a cotton ball, which just wastes toner), then wipe your face gently with the toner pad until the pad is no longer accumulating any gray- or tan-appearing residual gunk. 

I recommend trying our BeautyRx Balancing Cleanser + Purifying Toner.

Exfoliate

After cleansing and toning at bedtime, apply your glycolic exfoliant serum or pad evenly and lightly to your entire face. Remember that with all skin care products, “less is more." This is the most important step in the treatment of your acne because of the triple action of daily glycolic in (1) reducing oil, the root cause of acne, (2) removing the clogging dead cells from the pores that cause clogs, and (3) accelerating the removal of surface cells on top of zits to make them disappear faster.

Not all glycolics are created equal, so make sure yours is balanced, buffered, and pH adjusted, which makes it gentle enough to use every night but potent enough to remove all the clogging dead cells. Shop our collection of exfoliants here.

Spot-Treat

At bedtime after your glycolic, apply your spot treatment to the actual blemishes. If you choose to use daytime acne treatments, apply after cleansing and toning in the morning. The two most effective over the counter spot treatments are 10% sulfur and 2.5% to 10% benzyl peroxide. Shop BeautyRx Drying Lotion here. Topical spot treatments with antibiotics like clindamycin are available, but require a prescription. 

Moisturize

Lastly, use a water-based oil free moisturizer, BeautyRx Nourishing Moisture Cream is a great option, especially in the morning, to help prevent friction, the consequent maskne, and irritation from the rubbing that results from an effectively fitting mask/covering.

Masks are here to stay and so is “maskne.” But you can now be maskne-free. It just takes an understanding of its causes and simple measures that will take no more than 2 minutes, twice a day.

Your At-Home Regimen

Acne that's caused, driven, or aggravated by wearing a mask or face covering can be treated at home. Remember, I recommend a cleanser, toner, glycolic exfoliant, spot treatment, and moisturizer. Do this daily, and know that wearing a mask is critically important in controlling the spread of COVID-19.