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What to do About Skin Problems From Face Masks

Ep 27: Mask-Related Skin Problems – Causes, Treatment & Prevention

Chelsea: Hi guys welcome to our podcast Dermatologist Talks: Science of Beauty. In today’s episode we’re going to be discussing face mask skin problems – face rashes or other skin irritation, apart from maskne, that arise from wearing a face mask. 

One problem that some people have found that wearing a face mask for long periods of time has led to developing rashes, acne or other irritation.

What are some of the skin conditions that have arisen from wearing a face mask? How do they develop? 

Some facial rashes that can arise from the wearing of face masks, that’s also specifically not maskne, would include conditions such as frictional dermatitis. It can be recognized as a sort of contact dermatitis. Because, it occurs directly in the area that’s in contact with the textile. This form of frictional dermaitis due to the constant friction that arises from the fabric coming into contact with skin in an occlusive micro environment. This is distinct from the diagnosis of maskne. Which I described as the development of acne-like papules around the O-zone of the face, as characterised and described in my paper on maskne published in the Journal of the American Academy of Dermatology in November last year.

However, if you do have a case of verified contact dermatitis, that is not due to friction. It would be allergic contact dermatitis to the textile due to the dye or a residue treatment that has been applied to a textile. For example this would occur when a treatment is applied for preventing mould growth during storage. In particular, in the literature, there has been a case report of a healthcare worker who developed true allergic contact dermatitis. Due to the polyurethane foam that’s present in the sponge lining of the N95 mask. However, this is not common. It will not be the typical contact dermatitis we would expect to see in the general population.

The possibility of allergic contact dermatitis

Allergic contact dermatitis due to textiles is largely due to the dyes present. Or the chemicals used to color the fabric. The textile industry is not regulated. Furthermore, because the fabric mask is considered a relatively new invention in terms of widespread use for the purposes of the pandemic, it is not regulated. This means that most of the time the material that’s being used to manufacture these fabric face masks are actually the same sort of material as clothes.

However there is a distinct difference here as the fabric mask is in close proximity to your mucosal orifices such as your nose and your mouth. These are areas that have slightly higher risk of absorbing whatever it is in contact with. For example, if there are treatments with formaldehyde, then you would find that it’s actually carcinogenic. Furthermore, there have been studies which have been proven from skin models in a lab environment. That absorption via the skin can occur due to the exposure to textiles that have been treated with chemicals. In particular, the fabric mask is in direct contact with your mucosal area. This can increase the risk of absorption of any carcinogens.

Apart from the face mask, are there other contributing factors to irritation on the face? Could it be due to a change in skincare, or any of the product that I apply on my skin? 

A lot of the irritant contact dermatitis or other face mask skin problems that occurs from wearing of a face mask would be due to the textile skin friction that arises. In terms of allergic contact dermatitis as we mentioned, that is due to dyes. I really do not think that they are that common. Irritant contact dermatitis, however, can also arise from usage of acne creams which contain astringent ingredients. For example, retinoids, retinols, tea tree oil, salicylic acid, alpha hydroxy acids.

Traditional astringent ingredients

These astringent substances are traditionally used for topical treatment of mild acne. When they are applied on skin under the occlusive environment of the face mask, the absorption of these active ingredients increases. This means that the irritation potential of the ingredient is then greater. In turn, you would find that the rashes that arise as a result from that will follow the pattern of the area of occlusion. So when you notice that in an individual who is wearing a face mask. It will appear as a form of contact dermatitis. However, this may not be actually due to the mask. Instead, it could be due to the topical skin care that’s being applied. 

For example, benzoyl peroxide is a common acne cream ingredient that is not suitable for use under a face mask. Principally, because it is highly caustic – so it can irritate your skin. Secondly, it is because it bleaches fabrics.

Have you observed more individuals developing rashes on their face after wearing a face mask in your practice?

I would say that I have observed an increase in the number of individuals who suffer from pre-existing dermatological conditions who have had worsening of their skin rashes. Because of the friction and the microenvironment that is created on their skin in the area covered by the face mask.

If I have had skin conditions like acne or rosacea, but have not seen any increased reaction or irritation from wearing face masks, does this mean I won’t develop it in the future? 

This is unfortunately not true. If you have a pre-existing dermatological condition, then you’re definitely at risk of having it aggravated by wearing a face mask. Pre existing skin conditions would include perioral dermatitis, photosensitive rashes, rosacea, acne, facial eczema. These are definitely going to worsen from the occlusive microenvironment wearing a face mask creates.

Individuals with normal skin, over time, when they have an occlusive fabric over the face, can also develop a form of facial eczema. Because, of the re-circulation of the salivary and nasal droplets that contain enzymes. Saliva contains digestive enzymes, which is what we see sometimes see babies who drool. There is a constant presence of saliva on the skin. This can lead to a form of dermatitis or facial eczema. This can also occur in predisposed individuals. Or even in individuals with normal, healthy skin when they wear a face mask for prolonged periods of time.

Many people will not develop any problems

Fortunately, there will also be a lot of people who will not develop any problems. Healthcare workers, have for the longest time been wearing face masks, surgical masks, and N95 masks. For example, in an infectious disease unit, it is common to be wearing a mask throughout their entire shift. I think there are going to be people who do not develop skin reactions.

The same would be said of fabric masks made of materials such as polyester, cotton that is commonly found in reusable face masks. The main thing here is that a face mask is slightly different from wearing a textile on your body. Because, the face mask covers our orifices. The droplets that arise from these orifices are not meant to be in contact with skin. This can alter the pH of our skin. Also, if it contains digestive enzymes, over time, it can cause a break down of our skin barrier.

How can we prevent and treat face mask skin problems?

I think that it’s important to understand that as long as we are wearing face coverings, we are going to be at increased risk of developing frictional dermatitis and other face mask skin problems. This is not going to change because of the unique situation of the COVID 19 pandemic. However, we should understand the additional risk factors that can cause frictional dermatitis to get worse. Then, there are certain steps we can take to prevent or minimse the chances of developing skin irritation.

Firstly, prolonged duration of mask-wearing is a significant risk factor. Therefore, make sure to give your skin a break from wearing the face mask. If you’re going to be outdoors, it’s also going to increase the risk of skin irritation because of the sweat and humidity. Especially so in our tropical climate, which will result in an accumulation of moisture. Therefore, staying cool will definitely help.

Choose your fabrics wisely

The other thing would be to choose your fabrics wisely. The worst types of material for maskne is a polyester lining. These are the ones present in the surgical mask – because it is an occlusive fibre. Natural fibres such as cotton and silk are breathable. However, they also become saturated with sweat and get very heavy and uncomfortable if you are living in a tropical climate. This contributes to the sticky sensation you find on your skin and it can get uncomfortable when you’re speaking. Skin discomfort is a very important factor to address. Because, it is very often your body’s way of creating a feedback loop to inform you that what is present on your skin environment is not ideal.

Biofunctional textiles

What I have worked on is biofunctional textile that’s been published in the Journal of the American Academy of Dermatology as an ideal fabric mask design. This design coveres the orifices. At the same time, ensuring that there is still sufficient comfort on the skin for when you speak.

The design also incorporates metallic nanoparticles such as zinc and copper into synthetic breathable fibres that wick sweat away. This is something that you do not get with purely natural fibres. At the same time, the benefit of the biofunctional textiles is that they have a bactericidal. This is different from it being antibacterial or antimicrobial. It means that when the fabric comes into contact with your skin, it kills the bacteria. If you have maskne, it functions a little like a topical antibiotic. Also discussed in my paper is that there is no risk of antibiotic resistance with biofunctional textiles.

Bactericidal

Additionally, biofunctional textiles incorporated into fabric face masks can help with facial eczema. The bactericidal component of these textiles can reduce the effect of Staph Aureus colonization on skin. Which is responsible for the super antigen immune effect we see in flare ups of facial eczema. In particular, the Zincool zinc nanoparticle face mask is well suited for the treatment and prevention of facial eczema. Besides its bactericidal effect, it also maintains a healthy skin microbiome in terms of the flora.

face mask skin problems solution - biofunctional textiles

The ZINCOOL  Breathable Mask is self-cleaning with whiter than white technology. It incorporates superior skin cooling, creating a highly breathable skin microenvironment, with super evaporation coefficient. 

Furthermore, the microenvironment it creates is exceptionally lightweight. It is created with a whiter than white polymer technology. This means that it’s able to reflect heat and maintain a cool temperature of skin. It reduces the humidity because of the evaporation coefficient of the textiles. Increasing the rate of evaporation of sweat, keeping your skin dry and cool. Consequently, leading to a healthy skin microbiome. These are factors that will help in minimising the risk of developing any form of dermatitis on the face. Also directly reducing the risk of flare ups of pre-existing skin conditions. 

Could the rashes/ irritation on my face be due to an allergy? Who do I need to see for my facial irritation?  

The term allergy itself is very specific for a dermatologist. Not all rashes on your face that arises from wearing a mask, that is not maskne, can be directly described as an allergy. If you’re thinking of having to see an allergist – who is a doctor who is trained in Rheumatology – they deal with systemic allergic reactions. It’s extremely uncommon for an individual to develop anaphylaxis. Or have a systemic reaction due to an applied substance on the skin.

In this case, we’re talking about a textile that is in contact with your skin. However, there are rare cases of individuals who develop breathing difficulties from exposure to certain substances that you may be allergic to. In this case an allergist can potentially rule out the development of asthma, or asthmatic exacerbation becauses of the presence of polyurethane in an n95 mask.

Summing up

This is an example of a case study that has been reported in literature. For the purposes of this podcast episode, if you have facial rashes developed from wearing a face mask, then you should visit an accredited dermatologist. He or she will be able to evaluate if it is due to aggravation of a pre-existing dermatological condition, a brand new dermatological condition brought on by the specific microenvironment wearing a face mask creates, or if it’s directly due to frictional dermatitis, or an element of contact dermatitis, or other topical irritants that are probably a lot more potent when used under the occlusive effect of a face mask. 

This could be the topical skincare you’re applying, or even the accumulation of saliva that’s present on your skin when you wear the face mask for prolonged periods of time. Or in a rare case scenario of a true allergy to the textile itself – most commonly due to a dye used to color the textile.

Face mask skin problems

Overall, we should realize that the occlusive environment created by face mask wear will lead to a specific skin microenvironment that gives rise to a new set of problems for our skin, as well as aggravate pre-existing skin conditions. However it’s also important to note that not all face mask skin problems are maskne, and as we discussed, there are other dermatological conditions that can occur over the area covered by the face mask. It’s important that if you do develop any sort of rash or skin irritation, that you visit a dermatologist to diagnose the problem.

Well that’s it for today’s episode. You can follow Dr. Teo on her Instagram for the latest podcast update @drteowanlin and also visit us on our website at www.science of beauty.net. Thank you for listening and we’ll see you in the next episode.