Maskne: Why face masks cause acne—and what to do about it

I’ve spent a good 20 years of my life in and out of dermatologists’ offices in an effort to treat my cystic acne.

And while problem pimples are nothing new, my priority to wear a mask during the pandemic has brought me to new levels of zit-zapping agony. Why are so many of us breaking out under our masks? How can we treat this acne at home? And how can it be done affordably?

For some solid advice, I rang up dermatologist Dr. Jeffrey Hsu, who happily shared his expert info on how we drugstore patrons can steer clear of the latest skin condition popping up everywhere: Maskne.

Masking and cleansing

LL: Why do masks cause acne in the first place?

JH: This is a very common phenomenon these days. What most people notice is that it’s because of the heat, the oil, the sweat and the dirt that gets trapped under your mask all day. And in particular for essential workers—they may not be able to remove their masks throughout the day. The occlusion [blocking] of all of that material on your skin eventually leads to acne breakouts.

Is removing or refreshing your mask a way to prevent these breakouts?

Yeah, if you’re able! Obviously, clean your hands first for safety reasons—and then remove your mask and let your skin breathe a few times throughout the day. [Be sure to wash your hands after handling your mask as well.] That would be very helpful.

Are certain skin types more susceptible to mask acne, like oily or younger skin?

I do feel that people who sweat or produce more oil are susceptible to this.

I find that when I work out, I break out. If you wear a mask during exercise, what can you do to help with this sweaty situation?

If you could, cleanse your face with a gentle cleanser twice a day, in the morning and night. And one additional time—if you’re going to be working out, cleanse your skin immediately afterwards with a gentle cleanser.

Would that be like a CeraVe or Neutrogena?

Exactly. Something with not a lot of perfumes or additives.

How often do you recommend washing the mask? Is it daily? After every use?

Good point. That’s another method to prevent breakouts and prevent irritation. If you’re using a fabric, reusable mask, I would recommend washing [with an unscented detergent] or refreshing one every day.

What about different mask fabrics? Do you find that certain materials trigger more breakouts?

Absolutely. I think this does not only apply for acne, but for overall skin irritation. Breathable cotton is certainly preferable. I would avoid synthetic fabrics such as nylon, polyester, and rayon; they’re much more likely to irritate the skin and cause breakouts.

Moisturizers and makeup

You said irritation. Are you seeing people with other types of irritation, other than acne?

Yeah. To your point, acne seems to be more common with people with a sweatier or oilier skin type. But on the other extreme of the spectrum, people who are prone to dry skin, having the mask on the skin all the time can cause inflammation and irritation.

How would you go about treating dry skin irritation?

For the dry skin extreme person, you’ve got to pay attention to using the right moisturizer—even under the mask. People with oily skin, we tend to recommend gel moisturizers—ones that are very light that almost turn into water on the skin. People with normal or combination skin, a lotion moisturizer would be better. And people with dry or really dry skin, a cream-based moisturizer is better.

What about makeup? Does that collect in the mask and is cause for further breakout?

Absolutely! You know, these days, since you have to wear the mask anyway, more face makeup may not be as essential [laughing]. So, if you can skip it, skip it—because any sort of what we call “occlusion” to the skin enters the hair follicles may exasperate any acne propensity [or tendency] that you already have. So, that includes oil, that includes dirt, that includes sweat, and that certainly includes makeup.

Pimples and products

My mask zits are way more brutal than my normal breakouts. What types of acne are caused by masks?

You can get different types of acne just by wearing a mask, all ranging from comedonal acne, which is like black heads and white heads, all the way to the other extreme, which is inflammatory cystic acne—which are the red angry juicy ones that you can see across the room. So, you can present with any type.

I get the juicy ones! What would you do for over-the-counter (OTC) options to both prevent and treat those?

At Walgreens OTC, you can find some good treatment options. Ranging from a salicylic acid wash that’s been an old standard for many years. Benzoyl peroxide is also a good product to use for anti-acne. And these days, there’s something called adapalene—that’s the generic name, but the brand name’s “Differin.” It just became over-the-counter a couple years ago. That’s also very effective at fighting different types of acne, especially comedonal acne. Someone like you who’s bothered more by deep, angry inflammatory acne, then that may require prescription medications.

OK, that was my next question: When would you go to your dermatologist or health care provider? It’s if you have the nasty ones like me?

Yeah, not only because it’s unsightly and it’s uncomfortable, but it’s usually the deeper, cystic, inflammatory ones that cause acne scars—which are permanent, so you want to get on top of those things.

Which products can you wear under your mask during the day?

It may require some trial and error because, while in normal conditions when you use some of these medications, it may not cause irritation. But when you’re putting a mask over your face, whatever concentration you’re putting on your skin could become that much more powerful. So, you may experience a little more irritation than you otherwise would experience without the mask.

What about overnight treatments? I feel that those are very good for acne.

Absolutely. Adapalene is fantastic for overnight. It’s a strong medication, so using it at night when your skin can breathe, that’s actually not a bad time to use it.

What’s the purpose of all these products—to treat, to prevent or both?

When it comes to acne, a lot of people have this misconception that you treat the acne spots once you get them. But the key really is prevention. You can stop them from coming up in the first place—and that is much more efficient, effective way to go about treating acne.

Wearing a face mask is important to prevent the spread of COVID—even if it irritates your skin. With both mask protection and pimple prevention, hopefully, we’ll be in the clear sooner than later.

X, Lauria.

Dr. Jeffrey Hsu practices at Oak Dermatology in Itasca, IL, just outside of Chicago. Dr. Hsu completed his medical education at the University of California David Geffen School of Medicine at UCLA, and his residency at the Mayo Clinic College of Medicine and Science (Rochester).

Published on October 12, 2020