Nancy Widman said that when she first noticed the rash on her neck, she didn’t think anything of it. But it got worse, spreading down her throat onto her chest. Widman’s doctor attributed her condition to the cloth masks she had been wearing to avoid getting Covid-19. She recommended that she switch to paper masks, and gave her a prescription for medication.
“She told me it was definitely from moisture from my mask, and gave me cortisone cream and prednisone,” said Widman, who lives in Salisbury.
Dr. Paul Mustacchia, an internist and the chair of the Department of Medicine at Nassau University Medical Center, said he was familiar with mask-related acne, which was renamed “maskne” during the pandemic. “When I first heard the new name, I did a double-take,” he said. “The name has no scientific relevance.”
Maskne occurs when people wear tight-fitting masks for long periods of time. A mask creates a moist environment from breathing, talking or sweating, which can block pores, leading to acne or other skin conditions, including allergic contact dermatitis, rosacea, seborrheic dermatitis and folliculitis (see box).
But maskne is not new. Athletes who wear helmets or protective face and body gear have traditionally been susceptible to it.
Dr. Raman Madan, director of cosmetic dermatology and an assistant clinical professor at Northwell Health, attributes the increase he saw in maskne cases last May and June among non-athletes to pandemic mask wearing. In the early days of the health crisis, he said, people were reusing masks because they weren’t widely available.
“In the beginning, people didn’t know why they were getting [maskne], but some put two and two together,” Madan said. “I continue to see a steady flow of patients with it, but more than half are health care workers, because they wear N95 masks and a cloth mask over it, which creates more moisture.”
Health care workers have been double masking, Mustacchia explained, to preserve their N-95 masks. “The N-95 mask gives us a tight fit, creating a seal so organisms don’t get in or out,” he said. “That seal decreases the likelihood of contacting the virus but creates more moisture and heat.”
NUMC has treated close to 2,000 acute Covid-19 cases, Mustacchia said, making mask-wearing critical.
How to avoid getting maskne
To avoid getting maskne, both doctors recommended washing your face twice a day with warm water and a gentle cleanser, and moisturizing your skin afterward to protect it.
Madan advised against using an astringent or a toner, because they deplete the skin’s natural oils, which can cause inflammation and even more acne, he said.
“A lot of people chalk it up to being a mask problem and that there’s nothing they can do about it but there are options,” he said. “I recommend Tretinoin, which normalizes the skin and helps dry up oil glands. There are over-the-counter medications similar to Tretinoin that can also be used.”
The key to killing bacteria on a mask is wearing a cloth mask that can be laundered, Mustacchia said. “Maskne is from bacteria that may be one’s own native bacteria, which grows because of the warm covering from the mask,” he explained. “Clorox during laundering is great, as are other products for colored fabrics.”
Men with beards and mustaches who have maskne are challenged, he said. “It’s best to keep the beard and skin clean and dry,” Mustacchia advised. “Wax and antibacterial ointment is not recommended. Although people can’t see the maskne when someone has a beard, there’s a great deal of itching, which is a sign that there is an underlying problem.”
Even now, with mask mandates lifted in New York state for anyone outdoors, and for those who have been fully vaccinated, indoors or out, Madan said he continues to see many cases of maskne.
“I was surprised to see so many people with it,” he said. “I guess it was inevitable, but it was not under my radar until it happened. I noticed I was breaking out, too, from my mask.”