OMA Podcast Episode 31 - How to treat and prevent "Maskne" with Dr. Julia Carroll
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Voice-over: In this podcast the Ontario Medical Association looks at current health issues that are on everyone’s mind. Spotlight on Health gives you the straight talk. We’re Ontario’s doctors and your health matters to us.
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Anne Marie Flanagan: I’m Anne Marie Flanagan. I’m the Director of Media Relations and Social Media at the Ontario Medical Association.
Dr. Julia Carroll: And I'm Dr. Julia Carroll, a dermatologist based in Toronto, and on teaching staff at the University of Toronto Faculty of Medicine.
Flanagan: We're here today to talk about "maskne."
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Flanagan: Dr. Carroll, what exactly is maskne and what causes it?
Dr. Carroll: Well, maskne is a very hot term right now, and I think it really encompasses a number of medical conditions. So, I think it can be a type of acne, called acne mechanica, that you get from the mask rubbing on the skin, and then maybe some bacteria getting in there, and getting a secondary infection. I think it can also just be rosacea that's flared up because of the humid environment. Also, it could be a condition called perioral dermatitis, but it's basically red bumps under the skin in the mask area.
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Flanagan: How can you prevent “maskne”?
Dr. Carroll: The first thing is to look at your skin routine. And, I always recommend for my patients that they start the day off with a clean face, so just using a gentle cleanser. And at the end of the day, the same thing. They want to—once they take the mask off—they want to again cleanse with a gentle cleanser.
But also, you can use a barrier cream. So, if you're a frontline worker—those of us that work in clinics and have to wear masks eight hours a day, maybe
you're a grocery store worker, whatever it is—you want to use a barrier cream.
So, the idea would be you'd cleanse your face with gentle cleanser, put on a barrier cream, let it set—so you can give it 10 minutes to half an hour, that's great—and then put on your mask.
And I really recommend against wearing makeup under your mask. There's really no point, it just gets the mask dirty, and I think it really can flare this condition.
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Flanagan: So, in terms of a barrier cream, what do you mean by that? Are there certain types that would be more effective than others?
Dr. Carroll: In a way, you almost want to think about what you would use on a diaper rash. So, it tends to be things that have something that smooths out the area, so it could be something with a little bit of zinc in it—the same way we would use it on a diaper rash. DI methacholine is another ingredient.
And then if you're going to use a cream, also look for things that have niacinamides, ceramides, hyaluronic acid, just to help to hydrate and protect the skin.
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Flanagan: Once you have maskne starting, what's the best thing to use to treat it?
Dr. Carroll: It depends on the severity of it. What we sometimes do is just take a look at the skincare routine that the patient is using, and we will tweak that, and then we may add in an over-the-counter product, one of the barrier products or just a simple oil-free moisturizer.
But, if the condition has gotten to the point where it's been present for long-term, or we're starting to see scarring? Then, as dermatologists, we might recommend a prescription cream, or in more severe cases sometimes even pills to get the condition under control.
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Flanagan: When should somebody go to see their doctor? When do they know that their situation is significant enough that they should come and see you, for example?
Dr. Carroll: I think if you've tried to simplify your skincare routine based on these tips, you've made sure that you have a mask that breathes well, then it's time to go see your doctor.
If you've had it for longer than four weeks, or if you are seeing some permanent scarring from it, then I think that's something that warrants at least a teleconference with your doctor.
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Flanagan: And I know you touched on this a little bit earlier, that it's not really a good idea to wear makeup under masks; and why is that?
Dr. Carroll: First of all, nobody can see your makeup under your mask. And second of all, it makes the mask dirty, so it's an unpleasant thing to look at the inside of a dirty mask.
But then, you also have this product that could be occlusive on your skin, or it could be flaring breakouts. So, it could be making an existing condition like eczema, or acne, or rosacea worse, or it could be trapping bacteria under the skin and then creating that first flare of maskne.
The way I describe it for my patients is that with all of these conditions, it's like the highway on a long weekend; you're piling on all the extra things, and then you get that traffic jam, or in this condition you get that breakout.
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Flanagan: And, we've talked a little bit about different skin conditions. You've mentioned rosacea, I find that particularly interesting for me. I have rosacea, which I've had fairly under control after treating it, but I do notice, since wearing a mask more, it's come up a little bit on my chin.
So, are there particular other skin conditions that are made worse by wearing a mask or can flare up?
Dr. Carroll: For sure rosacea. We also find patients with eczema are struggling with masks, people that have acne as well. Those are the classic ones.
And then, I would probably add to the list also a condition called seborrheic dermatitis, which is when you get a little bit of scaling or redness just around the corners of the nose. That condition likes humidity, so in a condition of having humidity under the mask, it can flare.
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Flanagan: And is there anything people can do to try and prevent the flare ups? Obviously, we have to wear masks now when we're out and about.
Dr. Carroll: I think there's a few things you can do besides the topicals in the prescriptions that we talked about.
But I think you want to really think about when you can take your mask off and take some breaks from your mask during the day.
So, for me, I'll see maybe 10 patients, and then I'll come back, take my mask off, I'll wash my hands before, wash my hands after or use alcohol because, you also don't want to touch your dirty mask, and then after you've moved your mask, touch your face, because you could also create an infection or maskne that way.
The other thing is that, when you do have your mask off and if you're reusing a mask, you can put it in a Tupperware container, or I really like a paper bag, and that lets it dry out over time, and then you can reuse it. So, that's what we've been doing in our office.
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Flanagan: Now, we see a lot of people that they push the mask underneath their chin, and I know from an infection control standpoint that's not great, but is that an issue as well from a dermatological?
Dr. Carroll: I mean, it possibly could be because you're contributing to that mechanical irritation of the skin by moving the mask on and off over the skin. And then also while you are talking, you're further having your saliva pile into the mask as it sits below your chin. So, I haven't seen any studies on that, but you can think concept-wise that it's probably not the ideal situation.
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Flanagan: And do you have any tips on washing your fabric masks that might help prevent skin irritation?
Dr. Carroll: That's a great question. I just recommend that my patients use a fragrance-free, gentle laundry detergent, or even you can use a gentle dish soap. And, basically, you just want to stay away from things that have
fragrances or added botanicals in them because that can get into the fabric of the mask and it can irritate.
For some masks, I think even simple soap and water will probably do the trick. It just depends on how much coffee you had on the day you wore the mask or what you had for lunch, perhaps, and if you brushed your teeth in between.
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Flanagan: And have you noticed, is there any type of fabric mask that might be better or worse in terms of causing skin irritation?
Dr. Carroll: I think that from a skin irritation point of view, natural fabrics are probably better because they breathe a little bit more than some of the synthetics, but you do have to make sure that the mask you're using is still protecting you in terms of droplets and the virus. So, you have to find a balance there.
I like surgical masks, for me. As a physician, I have access to those – not everybody does – but I find they have a light fabric, they are breathable, yet when I breathe in and out, they have a good fit to the face so that I know they're doing their job.
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Flanagan: And do you think maybe this will improve a little bit with temperatures getting colder? Is a little bit of the issue, you know, people wearing them in summer, and being hot, and it's kind of sweaty under those masks?
Dr. Carroll: I think that when we're not in the midst of a humid summer it will improve, but then we're going to also have indoor heat which can be very drying, and then people will have the masks on. So, for some people it will get better, for other people, perhaps the eczema sufferers, it actually might get worse.
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Voice-over: This podcast is brought to you by the Ontario Medical Association. It is produced and edited by Jodi Crawford Productions. This podcast is not intended to provide medical advice for specific situations and is for general educational purposes only. Please consult your doctor if you have symptoms or questions about your health.
For more information, please visit our website at oma.org.
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