What Causes Maskne?

Episode 4: Maskne, the Skin Microclimate, and Photoprotection

Dermatology Weekly Flash Briefing – What are maskne causes? Join us in this episode to learn about the specific skin microclimate that wearing a face mask creates— exacerbating pre-existing skin conditions and creating the perfect environment for maskne. Microbiome dysbiosis – an imbalance in healthy skin bacteria which plays a role in many dermatological conditions – is implicated in the maskne micro-environment. 

Learn about how face mask wear poses specific challenges in sun protection,  relevant for prevention of skin cancers and in those with pigmentation concerns like melasma, sun spots (solar lentigo) and photosensitivity; and how the quest for skin lightening in Asia is not sustainable – and the rationale behind Dr.TWL Dermaceuticals’ Custom Makeup Lab which focuses on algorithmic color titrations to match your skin tone.

Chelsea: Hi everyone! Welcome to the 4th episode of Dermatologist Talks: Science of Beauty. I’m Chelsea and today we’re going to be talking to Dr. Teo Wan Lin about the common skincare problems she has seen as a practicing dermatologist in Singapore. In particular, skincare concerns that are unique to Asia. 

Lets dive straight in. You’ve been practicing in Singapore for a couple of years now.

Can you tell us some of the most common skincare problems people are seeing this year? What are some maskne causes?

Dr. TWL: I think the overarching theme this year in 2020, is related to the wearing of face masks because of the covid 19 pandemic. We’ve spoken about maskne, and maskne causes, but something I want to focus on is the occlusive microenvironment and unique skin microclimate of wearing a face mask. In summary, this can exacerbate pre-existing skin conditions such as rosacea, perioral dermatitis, eczema. The fact that you are breathing in and out of an enclosed environment changes the temperature, pH, saliva and respiratory droplets that are coming into contact with your skin. This changes the microbiological composition and skin microclimate of healthy skin. In short, what we call the microbiome dysbiosis is a result of this occlusive microenvironment, and will certainly affect your skin’s health. 

Dermatology PEARLS:  If you’re wondering what are the main maskne causes, according to Dr. Teo, an accredited dermatologist, is that it has to do with the skin microenvironment. Skin microbiome imbalances cause bacterial dysbiosis, which may be triggered by a humid tropical climate like Singapore.


Pigmentation concerns remain a perennial issue. Individuals are generally more conscientious now than a decade ago about applying sunscreen. Because, sun exposure is well established as a link to various types of hyperpigmentation disorders. Additionally, it is also key in the development of skin cancers. In short, face mask wearing poses specific challenges because of the occlusive microenvironment and skin microclimate, which increases the comedogenicity of sunscreen.

With both phenomena existing in the current dermatology landscape, I proposed in my original white paper in JAAD, that UPF50+ UV-protective, biofunctional textiles should replace the wearing of sunscreen for the lower half of the face. As it is the gold standard of sun protection. Primarily, it’s going to be difficult to constantly reapply sunscreen when you’re wearing a face mask. Nonetheless, it is also important to understand that a lot of facial sunscreens are not formulated to be water-resistant. The more water-resistant a formula is, the higher lipophilic component, which increases the comedogenicity of the sunscreen as well. 

Chelsea: Moving on to skincare concerns that are particularly relevant here. Here in Asia, there is a pretty big obsession with lighter skin.

What is your take on the popularity surrounding lighter skin and skin whitening products and treatments in Asia?

Dr. TWL: Culturally, fair skin has always been valued in Asia. With the evolution of societal values as well as our knowledge of dermatological science, it is increasingly apparent that one should not strive to change your skin tone. Any of these methods, such as so called ‘skin lightening’ methods like intravenous vitamin C, or glutathione injections are not backed by sound dermatological research. In short, at the very worst, they are dangerous, and at best, unnatural and unsustainable.

In some parts of the world, prescription bleaching creams containing hydroquinone, as well as high doses of topical steroids are readily available. These certainly bleach the skin, but not in the way we think is healthy. In fact, it has many side effects and dangers. For example, when your skin undergoes such artificial depigmentation caused by topical steroids and hydroquinone, you’re actually increasing the risk of developing skin cancers because you lose the photoprotective effect of melanin. In addition, there can be irreversible skin thinning in the form of stretch marks, and other forms of pigmentary changes. 

Chelsea: Yeah, I remember growing up, that I was always advised by the older generation around me that my skin tone was too dark, comparing me to cousins or friends.

Wanting to have fairer skin is a common sentiment I know many have experienced, what is your view on that? 

Dr. TWL: As a dermatologist, I want to emphasize that there’s no better time than now for society to embrace authenticity. The message is simple. We should embrace our natural skin tone, as healthy skin is beautiful skin.

Chelsea: I think you’re absolutely right. If there’s one thing we should take away from this, is that healthy skin is beautiful skin. Well that about sums up our episode, thank you guys for tuning in, and we’ll see you on the next episode.

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Read more about Dr. Teo’s latest research paper here:

Ep 4: Maskne, the Skin Microclimate, and Photoprotection

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