How is our skin affected by wearing a face mask?

The physical presence of a face mask brings a few changes for the facial skin in the area where it is worn. Providing its effectiveness as a protective mask, there is less ventilation i.e. exposure to the usual atmosphere for our face. The mask creates a small micro-environment above the nose and mouth with elevated temperature and increased levels of humidity due to exhalation and sweating.

Masks that are not cleaned or changed regularly can become a reservoir for trapped skin lipids and bacteria, the latter of which thrive in the high humidity of the mask-microclimate and feasting on sebum and dead skin cells can become a source of impurities and an unbalanced microflora of the skin. If worn too tightly a mask can provide a source of friction and chafing which can ultimately translate into a disrupted or at least impaired skin barrier. This in turn can lead to dryness with all its symptoms like a flaky or ashy appearance and even to irritation and redness.

With reusable fabric masks being popular it is also possible that the use of a detergent to clean the mask causes a contact dermatitis-like sensitivity or reaction.

What does the skin need after a full day behind a face mask?

There are various strategies to care for mask-affected skin and depending on the likely causes and types of symptoms, different measures can be taken. The ultimate objective in any case is to reassure and support the skin in its function as a protective barrier.

Regular cleansing in order to clear the skin of any mask-derived dirt or trapped bacteria is a very important step. However, the type of cleanser, as well as the cleansing strategy, can have a big impact on the skin barrier and as such on the skin´s hydration levels and Trans Epidermal Water Loss (TEWL). We recently wrote in our article about dry hands on how to select a gentle cleanser and also what steps of a cleansing routine can exacerbate or soothe dry skin.

A light moisturizer with barrier enforcing technologies as well as soothing ingredients for aggravated dry-skin can provide relief and help the skin stay hydrated without being overloaded with heavy lipids.

Skin that has been affected by chafing requires more intense barrier-repair when off mask-duty. Applying an occlusive balm locally in these areas can be supportive. Also wearing a lubricating or slip-providing product in the areas that are subject to friction while the mask is worn can be helpful. Vaseline or products high in slip enhancing silicone provide a good and affordable option. Chafing and dryness can also affect the lips if individuals are required to move their mouths while speaking over extended periods of time. Wearing a lip balm can provide protection and moisturization.

What is “mascne”?

Another symptom that regular wearers of PPE, like masks and helmets, have been familiar with for a long time, but now a broader part of the population is experiencing, are acne-like symptoms such as impurities and localized inflammation around pores and hair shafts. These symptoms often also referred to as “mascne” can be caused by increased microbial growth, favored by the increased humidity and potentially trapped sebum, dead skin cells, and dirt under the mask as well as the impaired barrier function of the skin. The latter can, through small cuts and stratum corneum disruptions from chafing or rubbing of the mask (micro lesions), allow foreign particles and microorganisms to enter the skin to a degree that would under intact barrier circumstances not be possible. This in turn can lead to an inflammatory response manifesting in typical acne-like symptoms.

What products and ingredients shall be considered to care for mask-affected skin?

A gentle cleanser that utilizes mild surfactant systems like a combination of surface-active agents including cocoamidopropyl-betaine, as well as moisturizing ingredients such as humectants and emolient-technologies is key. For more detail about gentle cleanser formulations and ingredients, you can find more information in our previous article about dry hands.

Using moderately tempered water during cleansing as well as a soft or gentle towel to pat the face dry as opposed to rubbing it is important in order not to further weaken a potentially affected skin barrier.

Barrier restoring moisturizers in a lighter formula during the day as well as a potentially heavier formulation for the night time, especially in very dry areas, in order to optimally support the skin barrier should be part of the skincare routine. Ingredients that include individual or combinations of Ceramides, as well as Cholesterol, are good options to support a mask affected stratum corneum.

Soothing and anti-inflammatory ingredients like Allantoin, Centella Asiatica Extract, as well as extracts of Chamomile, standardized onto Azulene or Bisabolol, can provide extra relief. Individuals with tendencies to contact dermatitis from essential oils and terpenoids, should be cautious of the contact dermatitis potential of chamomile extracts, however, and make sure that they can tolerate selected products by means of a patch test prior to purchase.

For local impurities, targeted treatments containing Salicylic acid, Niacinamide, or Tea Tree Oil can be a supporting solution. CAVE: Tea Tree Oil in high concentrations can have irrational potential. Individuals with tendencies to contact dermatitis from essential oils and terpenoids, should again, make sure that they can tolerate selected products before making a purchase. Small hydrocolloid patches, which can be applied to individual areas of the skin can provide absorption of fluid from spots as well as provide an additional barrier under which the skin can regenerate.

Areas that are subject to pressure or friction due to mask-wearing during the day can benefit from the application of a protective balm rich in petrolatum and waxes. Pure Vaselinum Album is the most straightforward way of achieving not only moisturization but also lubrication for affected areas.

What steps should be taken in order to optimally support mask-affected skin?

To optimally support the skin in rebalancing and restoring after a day of mask-wearing, treating it gently is the most important aspect.

If possible, letting the skin be exposed to its normal environment and atmosphere for as much time as possible will help the skin to regenerate, as the humidity balance will be able to recalibrate under regular conditions.

A cleansing step should be part of the routine in order to relieve the skin of sweat, bacteria, and any trapped dirt and excess sebum. Selecting a gentle cleanser, moderate water temperatures, and gentle drying of the skin are important in order not to impart strain on the stratum corneum. If cleansing is not possible, using a gentle, moisturizing toner with humectants like Glycerol or Butylene Glycol can be an ad hoc solution.

Special consideration should also be given to facial hair and well-groomed beards. By design is a place where impurities, sweat, and microbial growth can lead to itching and discomfort, sporting a beard under a mask can potentially cause or exacerbate these symptoms. Additional care should be given to the facial hair areas with respect to cleansing with a mild cleanser or a designated beard shampoo. Specially designed conditioners that can help soften longer beards and can potentially help make wearing a mask more comfortable. In any case, the cleansing step should be followed by a moisturizer, ideally with barrier restoring properties.

Before wearing the mask, selecting a lighter moisturizer and preparing individual areas depending on their needs as well as applying a protective lip balm can provide protection for friction exposed areas.

Depending on which conditions are caused by wearing a mask, any skincare routine should be adjusted and tailored to the individual symptoms. In severe cases a professional such as an aesthetician with experience in barrier support or a dermatologist need to be consulted, however, a gentle, barrier supporting treatment is advisable in any case.

Which products or routine steps are better avoided with mask-affected skin?

Times during which wearing a mask is necessary are not the best times to introduce a new 12 step skincare routine or embark on a course of chemical exfoliation treatments. Keeping a simple routine that includes gentle cleansing, moisturization, and targeted treatment solutions is a good way forward.

Mechanical exfoliation like microdermabrasion or chemical exfoliation should be performed under professional supervision and might be a better option to hold off with until the skin barrier is not undergoing stressful mask-wearing on a regular basis for prolonged periods of time.

Wearing makeup is not contraindicated with a mask, however, heavy formulations or multiple layers of thick makeup can be replaced with a light, tinted moisturizer, BB or CC cream, or a lightweight foundation. While not removing makeup in the evening is never a good idea, this is definitely not the time to skip the cleansing step in the evening. Using a gentle makeup remover followed by gentle cleansing is key.

Finally, persisting symptoms and discomfort should always be discussed with and seen by a dermatologist. In return, wearing a mask on a regular base is something to mention to a treating aesthetician or dermatologist. Many treatments can be affected by the altered microclimate that a mask can create for the skin and the professional in charge should be aware if the client or patient is regularly wearing facial PPE.

 

References

  • American Academy of Dermatology Association, 9 ways to prevent face-mask skin problems, viewed October 07, https://www.aad.org/public/everyday-care/skin-care-secrets/face/prevent-face-mask-skin-problems
  • Chris Foo, Anthony Goon, Yung-Hian Leow, Chee-Leok Goh, Adverse skin reactions to personal protective equipment against severe acute respiratory syndrome--a descriptive study in Singapore, Contact Dermatitis, vol.55, Issue 5, P291-294, November, 2006
  • Emily Fiberger, Taking care of your skin while wearing a face mask, viewed October 07, 2020 https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/taking-care-of-your-skin-while-wearing-a-face-mask#:~:text=Preventing%20skin%20issues,%2C%20dirt%2C%20makeup%20and%20bacteria
  • Francisco José Navarro‐Triviño, Ricardo Ruiz‐Villaverde, Therapeutic approach to skin reactions caused by personal protective equipment (PPE) during COVID‐19 pandemic: An experience from a tertiary hospital in Granada, Spain [letter to the editor], Dermatologic Therapy, June 15, 2020, Online ahead of print, doi: 10.1111/dth.13838, accessed October 07, 2020.
  • H C Lee, C L Goh, Occupational dermatoses from Personal Protective Equipment during the COVID‐19 pandemic in the tropics – A Review, JEADV, September 7, 2020, Online ahead of print, doi: 10.1111/jdv.16925, accessed October 07, 2020.
  • Jiajia Lan, Zexing Song, Xiaoping Miao, Hang Li, Yan Li, Liyun Dong, Jing Yang, Xiangjie An, Yamin Zhang, Liu Yang, Nuoya Zhou, Liu Yang, Jun Li, JingJiang Cao, Jianxiu Wang, Juan Tao, MD, Skin damage among health care workers managing coronavirus disease-2019, JAAD, vol. 82, Issue 5, P1215-1216, May 01, 2020

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