Hello hello! Its been a while. This year has thrown a lot of unwanted surprises our way, and while it may not be the worst plot twist of 2020, we could all have done without a new skin problem cropping up on top of everything else. Maskne. A weird word for an unexpected problem. One of my favourite jobs back when I worked in skincare was helping people get to the root of their skin concerns. It was incredibly satisfying to work with customers to demystify their skin, and to see them reap the rewards. So when this issue started cropping up on faces all over the world, I couldn’t help myself from researching what maskne is, what causes it, and how we can get rid of it. Like with most skin concerns, it’s hard to find information that doesn’t have a skincare company’s spin on it (“only our product/treatment/service will cure you!”) and some of the advice I came across was genuinely horrific, so I thought I would put together what I learned, and eliminate anything I felt was ‘brandspeak’, in search of the best advice possible. So, here’s what I’ve got!
What is maskne?
To make matters more confusing, maskne isn’t just one thing. There are several different ways your skin might be reacting to your mask, but luckily none of them are particularly ‘new’ – they’re all well understood skin issues, it’s just that we’re experiencing them different ways and unexpected areas now. Even though it might not seem like it, most cases of maskne boil down to simple spots – it’s just that the causes and presentation might differ from what you’re used to. So let’s have a deep dive into what spots actually are, to help you understand what might be going on with your individual case of maskne.
Spots are caused by a combination of four things – dead skin cells and grime, sebum (the oil our skin naturally produces for protection), bacteria, and inflammation. Dead skin cells and grime (for most of us this ‘grime’ will be leftover makeup) get trapped on the skin by your sebum, and this gunky mixture settles into your pores. This is totally normal, but if your skin is struggling to shed dead skin cells, or it has more sebum than necessary, it gets worse, and the pore gets blocked. Some of the bacteria that naturally lives on your skin eats sebum, which means these pores are full of lovely food for them, so they chow down, and start reproducing (aka, infecting your skin). Your body notices this infection and sends the cavalry – your immune system – which increases blood flow to the area to fight the bacteria. This causes discolouration*, swelling, and everyone’s favourite thing, pus. Et voila, you have a spot!
It’s pretty common for dead skin cells and oil to settle and solidify in pores without the bacterial infection and immune response – that’s what blackheads are. It’s also possible for bacteria and immune responses to cause havoc on their own, without blocked pores – although this will look and feel different to a normal breakout, such as with folliculitis, which is a bacterial infection that causes itchy, burning, tender skin and blisters (more on that later), or eczema, which is a purely immune response. Wearing a face covering doesn’t do anything other than trigger these processes, it’s not a new or particularly surprising eventuality. And there are lots of ways you can combat it, so keep reading!
How to treat maskne
Now that we know what spots are and why we get them, all we need to do is think about what’s happening under that face mask to cause a breakout of maskne. I’ve broken it down into the four different causes of spots, and shared pandemic-specific solutions for all of them.
Dead skin cells
A buildup of dead skin cells and grime means more gunk in the pores. When wearing a mask, it’s possible that the protection it offers is preventing your skin from shedding skin cells like it usually would – the lack of moving air and higher humidity levels are perfect conditions for preventing airborne viruses from flying around, but it also means that your skin’s usual ‘sloughing’ process could be interrupted too. Masks can also create friction, which rubs dead cells and makeup into the skin, physically creating extra blocked pores for bacteria to flock to, causing a type of breakout known as acne mechanica. This is something that most commonly occurs on our backs, and other sebum-rich areas which have clothes rubbing against the skin a lot, like the chest or thighs. It wasn’t often seen on the face, until now of course!
Solution: exfoliation. Gentle, daily chemical exfoliation like Pixi Glow Tonic or Aesop Parsley Seed Cleanser should help your skin to catch up on its shedding schedule. But be careful – if you’re getting irritated rashes or blotches, but aren’t noticing an increase in blocked pores or spots with definite ‘heads’, you might actually have the opposite problem. Your skin could be being over-exfoliated by your mask! This is more likely to happen around the edges of your mask, particularly if you’re wearing an N95 or similar style. If you think that might be what’s happening, scroll down a bit and have a read of the immune response section. If you wear makeup under your mask, it’s also a good idea to use a lighter layer so that there’s less stuff on your skin to get compacted into your pores. I’ve been skipping makeup below the mask entirely, l but if I was going to wear some I wouldn’t bother buying a BB cream (if you have one already though, go ahead!) I would just use an ultra thin layer of my normal foundation.
Your skin is covered by a very delicate layer of oil and water called the hydrolipidic film. When this layer becomes disrupted, your skin tends to react by producing more oil. Unfortunately, your skin doesn’t quite know when to stop, so it tends to produce an excessive amount of extra oil, leading to spots. In the case of maskne, if your mask is absorbing too much of your sebum, you might experience excess oiliness as your skin tries to compensate, and if your mask is causing friction, your skin might be producing oil for extra protection.
It’s a total myth that humidity and heat makes your skin oily – something that skincare companies and lifestyle websites love to peddle in order to get people to buy mattifying products in the summertime, but actually, when your face gets shiny in the warm weather, its sweat, and if it gets spotty, it’s probably a reaction to your SPF, a heat rash, or your skin over-producing oil in response to those mattifying products. Anyway, that’s a pet hate of mine, sorry to rant! My point is, you don’t need to worry about the humid climate inside your mask contributing to oiliness.
Lastly, it’s important to take into account the fact that oil levels are affected by hormones and stress. This is why so many people get acne when they’re going through a tough time, and let’s face it, who isn’t going through a tough time right now? Hormonal and stressed out skin is a whooole other topic that I can’t really cover in this already very long blog post, but rest assured, there is a lot you can do if that’s the cause of your skin issues!
Solution: balance. Choose daytime products that will intensely hydrate your skin without being too oily – Jordan Samuel Serum and Caudalie Moisturising Sorbet are great examples of this kind of product. Whatever you choose to buy, when shopping for daytime skincare, look for hydrating ingredients like hyaluronic acid, ceramides, glycerin and squalene. A few nights a week, use a replenishing oil like The Ordinary Squalane, or Trilogy Rosehip Seed Oil, which should soothe, help healing, and encourage your skin to slow down its own oil production. If your skin is naturally oily or combination, don’t use a face oil too often, make it a Sunday night treat and use a lighter oil like Weleda Almond Facial Oil. You could also try a silk mask, because silk doesn’t absorb oil like cotton and paper, so it shouldn’t kick your skin into oil-overdrive.
Of all the spot-causing issues, when it comes to maskne, bacteria is probably the least of your worries (ironic considering that this is all happening because of another microscopic menace). The only thing you need to be aware of is that bacteria can be transferred to the fabric of your mask and then back to your face, causing bacterial overgrowth. Make sure you wear a clean mask every day, but there shouldn’t be any need to change it throughout the day, unless you have very oily skin or you haven’t washed your face that day. Although it might seem counter-intuitive, you don’t need to worry about humidity or heat causing bacterial overgrowth, because Cutibacterium acnes (the bacteria that causes acne) doesn’t care about external humidity levels or air flow – it lives in your pores, it’s always wet and warm in there!
Solution: gentle cleansing. Your skin’s microbial ecosystem is delicate, and essential for maintaining skin health. The best thing you can do is keep up a regular, gentle cleansing routine to keep your bacteria nicely under control. My favourite cleanser for this is Aesop Parsley Seed Cleanser, but if you prefer non-foaming cleansers, I also love Fresh Soy Face Cleanser. Personally I don’t think it’s a good idea to use anti-bacterial agents daily (stuff like witch hazel or salicylic acid toners) because they can destroy the ecosystem on your skin, doing way more harm than good. If you want to use something with anti-bacterial properties on your face, make sure that a) it’s designed to be used on the face, and b) don’t use it daily. When my skin is acting up, I love to use Caudalie Vinopure Toner, which has salicylic acid, but it’s very astringent, so I only use it as an occasional treatment. Lastly, remember that severe acne can be treated with an antibiotic prescription, so keep that in mind if things are getting out of control.
This one is a bit more complicated – I want to incorporate some stuff that I glossed over earlier, and mention types of maskne that are not necessarily ‘spots’, but may occur alongside them, and may be confused for them. All forms of skin irritation are immune responses – from swellings to rashes to cysts, the bit you notice is actually created by your body, not by whatever has irritated it. And there are a lot of different ways that wearing a face covering can trigger immune responses/skin reactions. It’s really important to look closely at your skin, and be aware of the symptoms of skin conditions. Although the environment under a mask isn’t particularly extreme, and is unlikely to cause anything serious, if you’re at all worried that it might be ‘more than maskne’, do try to see a doctor. Warning signs might include widespread discolouration* and soreness, itchiness, flaking, or painful rough patches. However, if you’re confident that it’s nothing serious, there are lots of things you can try.
Solution: calming, gentle products. I’m not above putting porridge on my face when it’s really irritated, as oats are fantastically calming, but it’s messy, and there are better recommendations. Avene Tolerance Extreme Emulsion is my holy grail skincare product – it’s the simplest moisturiser imaginable, and will hydrate and protect your skin without any potential irritants. If your skin is in need of extra protection, (if you’re suffering from over-exfoliation for example) then opt for Avene’s Skin Recovery Cream, which contains mineral oil to create an invisible protective layer over your skin. When it comes to calming the irritation of spots, simple is always best, so gently apply a warm compress on unbroken spots. I also sometimes use Caudalie Purifying Mask on unbroken spots, as I find it helps reduce swelling, but doesn’t dry out the swollen, irritated skin covering the spot (like every other mask or treatment that I’ve tried). While it’s usually best to leave open spots completely alone, I will sometimes apply a tiny amount of Germolene with a very clean fingertip, and I do find it really helps me.
I’ve seen some places recommend the use of barrier creams under masks – and while this may be a good idea for people wearing N95s, a barrier cream will present a whole new set of problems for the average mask-wearer, because non-prescription barrier products like nappy creams are extremely thick, pore clogging products. If your skin is getting very irritated and causing you discomfort, you could always ask a doctor for a medical grade barrier product, like Cavilon (which is used in incontinence care and for the prevention of pressure ulcers in bedbound patients).
Lastly, try a softer mask, like the silk masks as I suggested above. If you’re wearing paper masks a lot, perhaps you could put a thin, soft one underneath? Avoid masks with protruding seams, and while you should definitely make sure it’s secure along the edges, try to wear one that isn’t super tight all over your face (this is better for infection control too I believe, because it’s the layer of humidity inside the mask provides important protection from the virus).
I think one of the key things here is not to overdo anything in your quest to eliminate maskne. I’ve seen recommendations like “wash your face in the middle of the day!” and while I see the logic, overwashing your face can lead to an increase in oil production, as the skin barrier (that hydrolipidic film I mentioned) becomes compromised, and can also cause dermatitis and bacterial imbalance. Make slow, gradual changes to your skincare and focus on treating your skin gently – remember that just like you, it needs time to adapt to our new world, so treat it nicely.
*a note on discolouration – often in Western skincare we talk about ‘redness’ but the colour of a skin condition is completely dependent on melanin levels – for example, eczema resembles a kind of rough textured hyperpigmentation on some skin colours, and red blotches on other. The term ‘discolouration’ might not be perfect, but it’s better than just saying ‘red’.