Long gone is April, bringer of showers and worldwide, pandemic-related closures—now we’re deep in May, flush with flowers (thanks, showers!) and getting used to a whole new way of living. We’ve been spending more time than ever wearing protective face masks, for one thing. And you can blame those masks for an increase in inflammatory skin conditions. “I am seeing more acne, rosacea, perioral dermatitis, and irritant contact dermatitis,” says Dr. Dan Belkin of the Laser & Skin Surgery Center of New York, who’s been keeping up with his patients from home using telemedicine. Part of it is moisture—when you wear a mask, the warm air you exhale is trapped close to the skin. “The increased humidity around the nose and mouth can cause bacterial or fungal overgrowth we might normally see in dark, moist places of our body,” Dr. Belkin explains. But humidity’s not your only enemy here! Friction and pressure around the edges of a mask adds extra irritation where your skin is already the most fragile.
Of course, the severity of your symptoms will depend on how long you’re wearing your mask, and what kind of mask it is. Medical professionals, who wear tight masks all day, should focus on mitigating inevitable irritation for as long as they can. “Prior to COVID, masks were intended to be single use and worn for short periods of time,” says Dr. Belkin, “and now, we are reusing them and wearing them for longer periods of time.” These changes have allowed humidity-loving, rash-causing bacteria to proliferate, and ushered in deep red divots on the face. (Even if you’re not a healthcare provider, you’ve probably seen photos of them on the news.) But chances are your mask will be made of fabric, worn only to venture out to the grocery store or on a mental-health loop around the block. The effects you experience won’t be as severe, though there are still certain important changes to note.
If you’re a friendly neighborhood mask-wearer:
Wash your mask frequently
Just like washing your sheets and pillowcases frequently can help prevent breakouts, keeping a fabric mask clean makes sure all the dirt, oil, and bacteria from days past doesn’t re-accumulate on your skin every time you put it on. “Fabric masks should be washed frequently to prevent bacterial overgrowth from moisture,” says Dr. Belkin, which sounds like a no-brainer but is easy to forget. The CDC recommends washing a fabric mask routinely, and ideally you’d wash it after each wear. To do it right, wash in hot water (if you can’t put it into the washing machine, make sure you scrub it well for at least 20 seconds) and dry with heat.
Be smart when cleansing
Dr. Belkin recommends washing your face every time you remove your mask, which might leave you cleansing more than two times a day. That’s why it’s more important than ever to stick to a gentle cleanser (leave the scrubs and foams for later), and cold or lukewarm water to keep your skin happy. Still, all that extra cleansing will take a toll. “Increased face washing is going to cause dryness,” says Dr. Belkin, “which can worsen acne and irritation.” If you are noticing more breakouts than usual, working in an antibacterial wash with benzoyl peroxide or sulfur can help. But Dr. Belkin recommends sticking to using it just once a day, max—anti-acne cleansers are often drying, and they’ll work best when offset with your favorite creamy or oil-based cleanser the rest of the time.
Keep your routine gentle
You don’t have to do your entire skincare routine after each cleanse, but you do have to use a moisturizer. And your regular go-to moisturizer might cause newly dry, irritated or sensitized skin to sting—if that’s the case, switch to something richer with minimal alcohol, essential oils, and fragrance. (Lots of good recommendations for sensitive skin moisturizers, right this way.) As for the rest of your products, “Be careful with acids or retinoids, as these can worsen irritant contact dermatitis and perioral dermatitis,” says Dr. Belkin. Is that advice coming in hot and… too late? On super red, dry, itchy areas, Dr. Belkin recommends slathering on a little over-the-counter 1-percent hydrocortisone cream to reduce inflammation. The topical steroid won’t help if you’re struggling with acne or chronic conditions like rosacea and PD, but it’ll temporarily calm patches where you overdid exfoliation.
And if you’re a medical professional:
Moisturize—a lot
The combination of pressure and irritation from wearing tight medical-grade masks for longer than usual can cause pressure sores, tender ulcers prone to infections if left uncared for. “The thin skin on the nasal bridge is the most common area of breakdown,” adds Dr. Belkin, though he also says to watch the area behind your ears, where the straps of a medical mask can leave itchy dents. To prevent red spots from breaking down into sores, Dr. Belkin emphasizes consistently moisturizing the skin with a rich cream, even when it feels gross under a humid mask. And, while you sleep, cover any injured areas with a thick healing balm like Aquaphor.
Try to minimize pressure on your skin
Creating a barrier between your skin and the mask can help mitigate some of the irritation. After moisturizing, Dr. Belkin recommends spreading a silicone-based skin protectant (a smoothing primer can be used in a pinch) wherever the edges of the mask sit, like the nose and the cheeks. “Cotton pads behind the ears can help offload some pressure in this area as well,” says Dr. Belkin. Or, consider purchasing an ear guard, which attaches the mask’s straps behind your head to take pressure off of your ears.
Consider the possibility of an allergy
“Most rashes under your mask will be from irritation rather than allergy,” says Dr. Belkin, who recommends trying hydrocortisone on any red, itchy patches that crop up. But if you’re experiencing prolonged, increasing itchiness, you might be allergic to a component of your mask. Since you can’t stop wearing the masks altogether, talk to a doctor about getting a prescription for a stronger topical steroid. It’ll help you manage the rashes until you can go back to less frequent use.
Photo via ITG