The agony of 'maskne:' why our skin is rebelling against mask wearing

Wearing masks for hours at a time can upset the skin barrier causing irritation. Photo / Brett Phibbs

Masks look set to be part of life for a while longer but some Kiwis' facial skin is not coping. Jane Phare looks at ways for mask wearers to protect their skin against rashes, infections and "maskne".

They're part of streetwear now, muffling noses, steaming up glasses, hiding smiles and littering gutters. Masks are here to stay, at least for the foreseeable future. But not everyone's happy about it.

My teenage son and his friends complain of not being able to breathe in class, and of outbreaks of "maskne" on their lower cheeks. The driver who dropped us at the Auckland Airport terminal from the carparking company complained of sores that became infected on both sides of his face from mask irritation. And beauty therapists say they have been busy, when not in lockdown, treating clients for outbreaks of spots at an age when acne should be a distant and distasteful memory.

So what's causing the mask mess? Turns out they can be grubby, bacteria-laden, damp germ-breeders that we put on and take off repeatedly, and stuff in our pockets, handbags, car consoles and sometimes the floor. It might make it into the family wash now and then but, more often than not, it's worn repeatedly – sweat, makeup, lipstick and all.

No wonder the skin barrier is rebelling, skin specialists say. They're increasingly seeing Kiwis developing what one therapist calls "mask face" as a result of long-term use of face masks. Skin specialists and beauty therapists are increasingly seeing rashes, acne, sores and allergic reactions on the faces of clients who wear masks for a good part of their day. And pre-existing conditions like rosacea, small, red pus-filled bumps on the face, get worse.

The DermNet New Zealand website, which is affiliated to the New Zealand Dermatological Society, says facial itch, redness, rashes, dryness and peeling, swelling and numbness, pain and tingling, and oily skin are commonly reported symptoms related to face mask usage, particularly when a mask is worn for more than four hours a day.

Workers like health professionals who need to wear masks for long periods of time are more likely to suffer from skin irritations and infections. Photo / Supplied

Auckland dermatologist Denesh Patel says wearing a mask all day can compromise the integrity of the skin barrier. The skin becomes hot and sweaty under the mask, upsetting the delicate balance of micro-organisms on the skin. That in turn can spell trouble, causing flare-ups of conditions like eczema and dermatitis, and blocked pores leading to acne-like rashes.

Patel's advice is to keep the skincare regime as simple as possible. Wash the skin clean using a mild cleanser, or just water, and follow up with a light, fragrance-free moisturiser. Makeup, facial scrubs, fragrances, and an array of lotions and potions will further irritate the skin, he says.

Wear a clean mask every day and wash fabric masks in mild soap, not harsh detergents or disinfectants. Patel, who is president of the New Zealand Dermatological Society, says he and his colleagues have noticed a sharp increase in patients presenting with skin irritation as a result of adding laundry antiseptics containing the chemical benzalkonium chloride.

Since the pandemic, people think they need extra additives to the family wash to make sure it's clean, he says. Instead, some have broken out in rashes where garments have close contact with the skin.

"There certainly has been a huge increase in the number of patients that we as dermatologists are seeing as a result."

One of the issues facing Kiwis with skin conditions is a shortage of dermatologists. Waiting lists are as long as eight months and some practices are not taking on new clients. And there's a woeful lack of dermatology services in the public system, with many areas in New Zealand having no access to a dermatologist at all.

But Howick skin specialist Dale Chandler says there are steps sufferers can take before needing to see a dermatologist, including diet and lifestyle for skin conditions like acne. Chandler sees hundreds of clients in her business, House of Aesthetics, and at an Albany medical clinic.

Auckland skin specialist Dale Chandler. Photo / Supplied

She too is seeing mask-wearing clients suffering from skin conditions including redness, dryness, itchiness, rashes, acne and sometimes sores caused by friction from an ill-fitting mask. Even those who have never been prone to acne are now finding themselves dealing with the ailment. The environment behind the mask is an ideal breeding ground, she says.

"If you're looking to grow bacteria in a petri dish you add humidity and heat and the bacteria will grow."

Wearing a clean mask every day, and taking a break from the mask whenever possible, is important.

"If you're using cotton masks you need seven to 10 to make sure they are washed regularly."

Wash them with a mild soap and don't use fabric softeners, she advises. Keep makeup light, and choose a mineral-based makeup, not one that contains talc.

Kohimarama beauty therapist Astrid Delaney has noticed a marked increase in clients presenting with what she calls "mask face". Men and women who normally had clear skin come in complaining about acne they haven't suffered from since being a teenager.

She's not in favour of washing disposable masks too many times because the fibres start to break down.

"Those simple blue and white surgical masks are made to be disposable, they're not made to be recycled," she says. "If we were to look under a microscope at the inside of a mask you would be shocked."

Skin specialists advise wearing a clean mask every day to help guard against skin conditions. Photo / Brett Phibbs

Ten tips to guard against mask face

• Wear a clean mask every day; change more often if you can

• Wash cloth masks well with a gentle soap, and either heat dry or dry in the sun

• Hand wash disposable masks with a gentle soap and discard after two or three wears

• Cleanse and use a light moisturiser on the skin before wearing a mask, and after you take it off

• Use a lip balm to keep lips moist

• Use a skin barrier repair cream at night if need be

• Keep makeup to a minimum. Thick makeup will clog the pores

• Make sure the mask fits well so that it does not rub. Take the mask off, even for five minutes, whenever you can take a break

• Change to a different type of mask or fabric if you experience an allergic reaction

• If specific materials cannot be avoided, put two layers of gauze or tissue inside the mask where irritation occurs