Combating What’s Under the Mask

March 9th, 2021
Combating What’s Under the Mask
Combating What’s Under the Mask
As countries around the world enforce the wearing of masks to minimize the spread of COVID-19, many people are asking how to deal with what is under the mask – irritated skin, acne outbreaks and other new skin problems. When we take off our patient’s mask, we discover that their skin is affected from months of being covered.
Dr Hen Ifrach, a Cosmetic surgeon from Milan, Italy, talks about “Maskne” and how to prevent it.

What is Maskne?

“Maskne” used to describe a skin condition caused by mask wearing although it is not a new phenomenon. It has been around for years in parts of Asia where the population wore masks as a protective measure against high levels of pollution. Medical personnel can also attest to the dermatological effects of prolonged mask wearing.

Why does it happen?
Face masks are occlusive and designed to block very small particles, so when we breath into the mask we create a hot and damp micro-environment. High humidity and hot temperatures have been correlated with acne flare-ups. This can be explained by the impact of temperature on sebum excretion which wasfound to be directly linked to local temperature changes and that sebum excretion increases by 10% for each 1°C rise. Studies have also found that high ambient humidity precipitates acne due to poral occlusion on skin hydration and irritation to the upper parts of the pilosebaceous duct. In addition, sweat and increased humidity might cause swelling of epidermal keratinocytes, thus affecting the keratinocytes of the pilosebaceous follicle and causing acute obstruction and acne aggravation.

Other contributing factors
• Repetitive rubbing while wearing and removing a mask causes the stratum corneum to peel off and deteriorating the skin’s barrier function, thereby promoting moisture transpiration, and makes the skin sensitive and prone to damage. This can also explain why acne is not the only skin condition caused by wearing a mask.
• The number of hours is also an important factor to consider when wearing a mask. Prolonged duration causes occlusion leading to dry, itchy skin and other face mask skin ailments such as: allergic contact dermatitis, rosacea, seborrheic dermatitis, and folliculitis.
• Stress and anxiety, which is abundant during the COVID-19 pandemic, is also known to impact skin conditions and can very well be a trigger for acne breakouts, a multifactorial inflammatory disorder . During stress cortisol is released in the body including the glands near skin hair follicles inside of the pilosebaceous unit. This hormone can escalate the production of sebum making it a favorable environment for P.acnes bacteria, initiating an immune response and leading to an inflammatory reaction .

Tips on how to prevent Maskne and other mask related skin conditions
These skin problems can be dealt with by starting with prevention, which is easier than you
might think.
? I suggest replacing your surgical mask every 4 hours and an N95 mask every 3 days.
? Place two layers of gauze inside the mask to reduce water vapor exhaled during
? If you already suffer from skin issues, use a hypoallergenic mask.
? If suffer from acne or sensitive skin, a cotton mask would be a better option for you.
Cotton is breathable and minimizes skin irritation, but do not forget to wash it
regularly and store the fresh mask in a bag to keep it clean.
? Wash your face and use a moisturizer immediately before putting the mask on and
after taking it off. Not only will this keep your skin hydrated, it will also act as a
barrier between your face and your mask, reducing friction.
? Make sure the mask is not too tight yet sits closely and seals.
? Those who find their face being damaged by mask related friction should consider
applying reparative creams or zinc oxide before wearing the mask as it forms a
barrier and helps reduce irritation and inflammation.
? If possible, avoid make-up and take a 15-minutes break from the mask every four
? Avoid new skin care products as it that can irritate your skin. Products that contain
benzoyl peroxide, retinols or salicylic acid will be more irritating to the skin

Treating the damaged skin
This unique skin condition forces us to come up with new solutions that not only treat the “maskne” phenomenon but also target any mask-related skin conditions.
For most patients, there is a need for a non-invasive, painless treatment with no downtime. My favorite approach is combining two different lasers not only to kill the P.acnes bacteria but also to protect the skin barrier and prevent any acne-related hyperpigmentation and scarring.

ClearSkin and ClearLift: 2-step protocol

ClearSkinAs a first step, I highly recommend the vacuum assisted, cooled ClearSkin; 1540nm laser. ClearSkin targets the underlying causes of acne including the colonization of P.acnes, high levels of sebum production, altered
keratinization, inflammation, and bacterial colonization of hair follicles on the face and neck. The vacuum head removes unwanted debris that clogs pores, while the cooling protects the epidermis, reduces pain, redness and swelling. This is fundamental for patients who cannot afford downtime and need to return immediately to daily routine and crucial for patients who are already in pain, suffering from inflamed acne.

ClearLiftI follow with the ClearLift, a 1064nm fractional Q-switched laser, a favorite of mine, as it is non-ablative, has no downtime or side effects and is a pleasant treatment that I can offer my patients. Studies have demonstrated that Q-switched 1064 nm laser acts on the skin barrier function, increasing expression of aquaporins, procollagen, collagen type I and elastin. ClearLift is gentle enough to treat areas that are typically too sensitive to treat with any other laser, such as the delicate skin around the eyes and mouth.

Parameters: ClearSkin: pixel tip, vacuum& cooling on, low fluence (400mJ), 3-5 passes. ClearLift: maximum fluence of 1800mJ using the medium depth tip, accumulating 3-5 kJ for the entire face in severe cases and over 5 kJ for the milder cases. If treating hyperpigmentation too I add on a few passes using the (+1) tip.
Treatment intervals: 2-4 weeks
This is a gentle treatment with low parameters – we need to remember that the mask is going back on after the treatment!
In summary, wearing masks is a new feature of our daily lives which means we ALL need to start adapting our skin-care routine and giving our skin the extra care it deserves!
Dr. Hen Ifrach is a graduate of the Faculty of Medicine and Surgery in Milan and holds level II Master’s degree in cosmetic surgery from the Humanitas Research Hospital. Practicing medicine for the past 7 years, she has a high interest in the use of non-invasive and innovative laser treatments, treating a spectrum of skin conditions such as acne, rosacea, melasma, hyperhidrosis and face rejuvenation.