Studies have conclusively shown that wearing face masks that cover the nose and mouth can help prevent the spread of the aerosolized droplets that can transmit viral particles from one person to the next. The U.S. Centers for Disease Control and Prevention now recommends that we all wear a cloth mask when in a public space.
But wearing a mask can present certain challenges, especially when it comes to skin health. As we adapt to the new protocols designed to keep us safer and slow the spread of this highly contagious disease, here’s what you need to know about how masks can impact skin health and how to mitigate these issues while complying with masking rules.
[Read: How to Get Rid of Mask Breath.]
Skin Problems Related to Masks
Dr. Susan Massick, a board-certified dermatologist with the Ohio State University Wexner Medical Center and associate professor of dermatology at the OSU College of Medicine, says one common problem associated with mask-wearing is skin irritation. “Skin irritation can be from the mask material, the fit of the mask or from repetitive daily use.”
Particularly for health care providers who are wearing surgical masks, N95 masks and other personal protective equipment all day long every day, skin irritation may be part of your new normal. Massick notes that these items “have varying degrees of filtration of airborne particles. The more efficient the filtration, the more occlusive the masks may feel, which can lead to skin irritation and acne breakouts under the mask.”
Massick notes that for a mask to be effective, it needs “to cover both the nose and the mouth.” This is great for helping reduce the risk of passing along the virus, but “when you breathe, moisture and humidity get trapped under the mask, which leads to sweat and increased oil production. The longer you wear the mask, the more your skin gets subjected to daily grime, sweat, bacteria and oil, which in turn leads to breakouts under the mask, a phenomenon now known as mask acne or “maskne.”
This isn’t the first time this sort of thing has happened, says Dr. Tanya Nino, a board-certified dermatologist with St. Joseph Hospital in Orange County, California. “This is a known phenomenon we have seen in other scenarios, such as with athletes who wear a helmet where friction and occlusion from the object traps dirt and oil in the pores, which leads to skin irritation and acne.”
What’s more, heat and moisture trapped next to the skin by a mask “can lead to overgrowth of the bacterium called Propionibacterium acnes, which causes acne breakouts,” Nino says. “This is especially notable in patients with sensitive skin or patients who are already prone to acne from increased sebum (oil) production or other factors.”
This means that “mask use, combined with the increased stress we have all experienced with COVID-19, has led many of my patients to have increased breakouts,” Nino explains.
Other Skin Issues
Dr. Brian Toy, a board-certified dermatologist and attending dermatologist at Mission Hospital in Southern California, says that “masks can also cause perioral dermatitis, a common rash which resembles acne but is treated much differently.”
Perioral dermatitis typically occurs around the mouth and is usually red, scaly or bumpy. It may produce a mild itching or burning sensation. Treatment typically includes a topical ointment or cream that suppresses that redness and inflammation.
How to Alleviate Mask-Related Skin Problems
Masks are about protecting yourself while also protecting others you come into contact with, and they’re one of the simplest ways we can prevent the continued spread of this ghastly disease. While there are plenty of ways that masks can be uncomfortable or create issues, there are also plenty of ways to make wearing a mask more comfortable, more effective and less irritating to your skin.
The following 14 tips can help you reduce or alleviate skin irritation, acne breakouts and other issues associated with wearing masks frequently.
— Get the right fit.
— Select your fabric with care.
— Size it appropriately.
— Double up.
— Don’t believe the hype about silver or copper.
— Don’t worry about cavities.
— Wash your mask after every use.
— Use an ear saver.
— Wash your face every morning.
— Wash your face every night.
— Wear a clean mask each day.
— Be careful if you remove the mask.
— Remove it fully if you’re taking it off.
— See a dermatologist.
[SEE: Eating for Your Skin.]
Get the Right Fit
One of the best ways to reduce irritation is to make sure your mask fits properly. “Masks should fit comfortably but snugly across the bridge of the nose and cheeks and under the chin in order to provide adequate protection from respiratory particles,” Massick says. “Remember no gaps — COVID-19 is a contagious infection, so any gaps between your skin and mask will leave you vulnerable.”
If your mask has a tight seal or ear loops, those can create pressure points on the cheeks, bridge of the nose, and around the ears, Massick says. “Relieving pressure from these areas can help minimize skin irritation.” But be careful not to introduce any gaps when adjusting the fit of the mask, as this can render it less effective.
Select Your Fabric With Care
The type of material you choose can also make a big difference in how your skin reacts to a mask. “Mask material should not feel abrasive or rough on the skin or cause itching when worn,” Massick says. Cotton is a good option because it’s lightweight, breathable and won’t irritate the skin. She also recommends choosing a “soft, non-abrasive material with a tight weave that is breathable with multiple layers,” which can better prevent viral particles from reaching your nose and mouth.
Size it Appropriately
Your mask “should fit snugly without gaps, so it’s not a one-size-fits all,” Massick says. And it makes sense that kids will need smaller sizes, and men may need larger sizes to cover the nose, mouth and under the chin.
For best protection, especially if you’re using a thin fabric, you should double or triple the layers covering your nose and mouth for added protection against the virus. Massick notes that extra layers “are better filters than a single layer alone.”
Layering is especially important if you’re using a thin, neck gaiter style covering, according to a recent study conducted at Duke University. That study found that aerosols can easily slip through the thin material that these tube-shaped stretchy items are made of and create smaller droplets that may linger in the air longer. Therefore, the researchers concluded you’re better off skipping that gaiter and opting for a tightly-woven cotton mask with multiple layers of material.
Don’t Believe the Hype About Silver or Copper
Some manufacturers have started adding silver and copper to mask fabrics, as these materials have antimicrobial properties. But Massick says, “in this case, don’t believe the hype. Weaving silver into the fabric of a mask does not make a mask significantly more protective than others. Masks can be protective, but don’t rely on gimmicks or assume you’re 100% protected just by the virtue of an antimicrobial mask.”
Toy agrees, noting that there there’s no evidence that sliver in the mask will make any difference for your skin, either. “Silver has antimicrobial properties and is often used in wound healing. However, its benefit in preventing acne has never been proven.”
Don’t Worry About Cavities
If you’ve heard some chatter about masks potentially causing a rise in cavities, don’t worry. “There’s no validity to the claim that wearing a mask for an extended period of time itself will cause cavities, so please don’t let this be a reason not to wear a mask,” Massick says.
The concern stems from the idea that “chronic mouth breathers have dry mouths from a lack of saliva, which dries the teeth out making them more prone to cavities,” she explains. “A dentist in Texas surmised that people wearing masks may tend to breathe through their mouths instead of their noses, which could lead to dry mouth and possibly increased cavities.” Logical, sure, but “at this time, there’s no data supporting the claim that a mask will lead to development of cavities.”
She adds that you should continue to see your dentist regularly and keep up with routine dental care. Brush your teeth at least twice a day with a fluoride toothpaste.
Nino agrees, adding, ” good dental hygiene, including flossing and brushing regularly, is likely the main component in preventing gum disease and cavities,” and mask wearing is not a big contributor.
Wash Your Mask After Each Use
Cotton masks are a good option because they can be washed and reworn time and again, and a mask that you can wash and reuse is better for the environment than a disposable mask. However, if you must use a disposable option, toss it after each use (in an appropriate receptacle, not the street or parking lot, please) and get a new one.
The CDC recommends washing your masks like you would any other laundry in the machine. Use the warmest water that the fabric can accept. If you’re washing by hand and the fabric can tolerate bleach, the CDC says to use 5 tablespoons (1/3 cup) household bleach per gallon of room temperature water or 4 teaspoons of bleach per quart of room temperature water. Let the mask soak for 5 minutes, then rinse thoroughly. Either allow the mask to air dry while flat, preferably in direct sunlight, or tumble dry on the highest setting the fabric can handle.
Any time you handle a soiled mask, be sure to wash your hands carefully immediately afterwards.
Use an Ear Saver
If the skin behind your ears has become inflamed from the constant pressure of loops, consider getting an “ear saver,” a simple plastic device that gives you a place other than your ears to loop the mask. You can also try a headband with buttons sewn just above the ears as an option for relieving pressure on the back of the ears.
Wash Your Face Every Morning
Massick recommends starting the day with “a gentle cleanser to wash your face,” and keeping your facial skin care regimen simple. Use a “light moisturizer with sunscreen but skip the makeup. Mascara, eyeliners and eye shadows are fine to use, but avoid heavy moisturizing creams and foundations which will lead to clogged pores and lipstick that will just rub off on the mask” and can make it easier for acne to develop.
Toy agrees that heavy makeup or moisturizers are a recipe for problems. “These items will only exacerbate the buildup of oil under your mask, clogging your pores even further, and cosmetics tend to soil the lining of the mask, making its reuse problematic.”
Wash Your Face Every Night
Toy says you should wash your face before going to bed to remove any dirt or built up oil from the day to help reduce acne outbreaks. Massick recommends using a “salicylic acid or benzoyl peroxide wash at night. For more significant breakouts, you can apply a benzoyl peroxide cream directly to breakout areas.”‘
Nino recommends that “patients with sensitive skin use a gentler cleanser if anti-acne washes cause irritation.”
Wear a Clean Mask Each Day
It’s important to start with a fresh, clean mask each day. Massick recommends keeping a spare or two with you if you’ll be in public for a long time so that you can “change out a mask if it becomes soiled or saturated.” A wet mask is far less protective against the virus, and a dirty mask will likely trigger skin issues.
Be Careful if You Remove the Mask
“If you remove the mask for parts of the day to get a drink or eat lunch or so on, always remember which is the outside (that’s the contaminated part) versus the inside (which is closest to the face) and keep it consistent when you put it back on,” Massick says. The whole point of the mask is to keep the germs on the outside, so if you accidentally reverse it when putting it back on, that defeats the purpose.
Remove it Fully if You’re Taking it Off
Massick also notes that you shouldn’t “slip the mask down onto your neck or up on your head, because as soon as you slip it back over your face, it’s now dirty,” and the oils from your hair and neck can clog the pores on your face and cause more acne outbreaks.
See a Dermatologist
Toy says that “mask acne, technically called acne mechanica, can be very difficult to treat. If you don’t have success with over-the-counter medications such as salicylic acid, benzoyl peroxide or adapalene gel, consult your local dermatologist.” Your doctor may be able to prescribe a more robust treatment that clears up the issue.
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