A surprising number of Jessica Wu’s patients have approached her in recent months with questions about random bouts of mask-related irritation. While they’ve been in quarantine, the Los Angeles-based dermatologist told me, her clients have become more fixated on their skin than ever before; most rarely wore masks for an extended period of time prior to the coronavirus pandemic. As a result, those with more sensitive or oily skin have been seeing minor complications: acne breakouts, flare-ups of eczema or rosacea, or general skin irritation.
Dermatologists have reported seeing more acne breakouts over the past few months, although masks are not the only reason. People’s bodies (and skin) are adjusting to quarantine, and a pandemic has left many people more stressed, depressed, anxious, and restless — all factors that could increase the production of cortisol, which in turn affects oil production in the skin.
In April, the Centers for Disease Control and Prevention advised the general public to wear non-medical masks and face coverings as a “voluntary public health measure” to slow the virus’s spread. Many states (or locales within states) have since issued mask mandates, requiring residents to cover their face in certain settings, such as on public transit and in grocery stores.
Many health care providers and essential workers, however, have been wearing specialized masks for hours at a time without taking them off since the pandemic began, to the point where many experienced painful skin breakage, chafing, and abrasions. Some have had to cushion their masks with bandages to reduce skin soreness, or readjusted straps around their head instead of around the ears.
While many people are now experiencing firsthand the discomforts that can be caused by mask-wearing, they generally aren’t wearing a medical-grade respirator for long stretches of time every day. There are many more non-medical mask options to choose from (which aren’t as protective as the medical gear reserved for first responders), as many clothing retailers and companies have shifted gears to mass-produce fabric masks.
For patients with sensitive skin, Wu advises against wearing any coverings that might have synthetic fibers, like polyester or spandex, as well as wool. “I’ve seen people running around with these wool neck gaiters and wraps they’d wear skiing,” she told me. “Don’t wear that. Many synthetic fabric blends are treated with chemicals that can irritate the skin, and they don’t tend to be breathable.”
Wu recommends wearing masks made out of natural fibers, such as cotton, bamboo, or natural silk to reduce the likelihood of irritation. Face coverings properly fashioned out of these materials might be an effective barrier to aerosol particles, Wu said, citing a study by the University of Chicago and Argonne National Laboratory. (One of the co-study’s authors, Supratik Guha of the University of Chicago, told PBS that a mask with 600-thread count cotton with two layers of silk or chiffon could provide adequate protection for wearers.)
“MANY SYNTHETIC FABRIC BLENDS ARE TREATED WITH CHEMICALS THAT CAN IRRITATE THE SKIN”
A mask or a face covering traps moisture within the enclosed space between a person’s face and the fabric. That humidity, especially in warmer temperatures, could lead to breakouts and, in some cases, contact dermatitis, an uncomfortable itchy rash on the skin. Since many people are exercising with masks, excess oil, dirt, and sweat could also be trapped, leading to breakouts around the chin, jaw, cheeks, or mouth area.
Heather Goff, an associate professor of dermatology at the University of Texas Southwestern Medical Center, described the skin as a seesaw. “The skin is in a state of equilibrium with outside air,” she told the dermatology news site Healio. “Changes in ambient humidity, either too dry or too humid, can trigger perioral dermatitis [around the mouth] in an individual who may be predisposed to developing it.”
Wu recommended using an oil-free makeup primer to reduce friction from the mask on the skin. Other over-the-counter products, like sulfur wash from your local drugstore, can further help treat breakouts. That’s why it’s even more crucial that people practice good hygiene, especially if they frequently wear a mask.
Generally, a person shouldn’t touch their face or apply any products before washing their hands. The same idea applies to masks. A person should ideally wash their face with a gentle cleanser and soap their hands before putting on a mask and after taking it off. Be thorough in cleaning your nostrils and mouth as well, Wu advised. “Before you go out during the day, put on moisturizer or makeup if you wear it, hopefully sunblock, and then your mask on,” she said. “We’re taught in medical school to not touch the outside of your mask, since you can contaminate it from the outside with unclean hands.”
It might be tempting to pull down your mask to get some fresh air, but health experts advise against doing so until you’re in a safe and contained environment, like your car or home. But what if it’s a nice day and you’re in a park all by yourself? If that’s the case, Wu said, a person should at least sanitize their hands and put their mask in a plastic bag or in a sanitary place so they can rewear it when necessary.
As the coronavirus pandemic continues, masks could become a staple health accessory in the US, in the way that they’re commonly worn in East Asia. Of course, that means Americans have to overcome their slight discomfort and, prior to Covid-19, the perceived stigma that comes with wearing them. Mask acne aside, Wu believes that people’s skin and their hygiene habits will adapt as time goes on. “My patients are surprisingly much more diligent about their skin care,” she said. “I do believe we’re going to hear less about it once people are more mindful of how masks affect their skin. Their next big concern might be mask tans.”