Why is my mask giving me a rash?

It’s a very common problem, says The Kit’s editor-at-large, with several possible solutions

“Wearing a face mask is mandatory these days to keep everyone safe and I do so, but I have a problem: While I have tried a variety of masks made of different materials (including 100 per cent cotton), all seem to cause my face to break out in a rash. Have you any suggestions? I am very prudent to wash the mask each time I wear it and have recently been careful to use a mild detergent.”— Joy, Waterloo

When my son started junior kindergarten, he hadn’t even turned four years old yet. He was so little that I had to hoof him up onto the first step of the school bus because he couldn’t manage the leap under the girth of his giant backpack.

I had channelled all my preschool jitters into researching and buying the “perfect” lunch box, as if the right one would ensure his smooth transition. (Spoiler: He spilled his lunch on the floor every day for a week anyway but survived.) This crazy, crazy year, my son started Grade 1 and I fell into a panic trying to figure out which masks would be comfortable and wouldn’t aggravate his eczema and would save him from this madness and would withstand his desire to lick the inside periodically. Of course, the stakes are so much higher now than they were when I was stressing needlessly about lunch boxes but, regardless, change is hard and stressful. Even for your skin.

I applaud your commitment to doing the right thing despite your discomfort (you’re doing so many things right!), so let’s try to protect your skin while you’re protecting others. I called Dr. Sonya Abdulla, who is a leading dermatologist who practises out of the Dermatology on Bloor office in Toronto, to discuss your concern.

“Generally, we need to first look at whether it’s a pre-existing skin condition that’s getting aggravated or new onset condition,” she says, noting that the most likely culprits for this common issue are acne (now with the trendy nickname of maskne, trademark pending), rosacea, eczema and psoriasis. “These conditions can flare up for a number of reasons but, in this case, it likely boils down to friction from the mask irritating the hair follicles, occlusion from the mask itself or the humidity trapped in by the mask, which creates a breeding ground to disrupt the skin barrier.”

But before we get into how to overcome those challenges, let’s take a moment to really get specific. “The word ‘rash’ doesn’t actually point us in any particular direction,” explains Abdulla. It’s really about as descriptive as telling a realtor you want a house. Do you want a charming cottage by the sea or a midcentury bungalow with a view? (I’d happily wait out the pandemic in either of these, to be honest.)

“So the things that I typically ask patients about are symptoms — is there burning, itching or tenderness? — and the characteristics of the skin: Is it smooth and red? Is it flaky or bumpy? Are there pustules? These are the details that will ultimately dictate the treatment.” So have a careful look and gain an understanding of the rash and how it changes, which is really important information you can give a doctor.

Your first line of defence when dealing with any rash, however, should be to dial your skin care routine way back to avoid causing any irritation. Use a gentle cleanser and light water-based moisturizer and avoid vigorous exfoliation (chemical-based products like AHAS, cleansing brushes, microbeads: We’re looking at you); you should also steer clear of potential irritants like fragranced products or face wipes. Then it’s time to make sure you’re not clogging your pores, so your skin can breathe and heal.

“The No. 1 thing that triggers occlusion, particularly for women, is makeup,” says Abdulla. So consider skipping foundation under your mask while your skin recovers — especially since it might actually be causing the problem. “The other products to consider are facial oils. We know that it’s very trendy to use oils in skin care right now but, under a mask, they can be occlusive and can also disrupt the barrier to trigger inflammation and aggravate an inflammatory condition.”

Lastly, it’s important to know that masking can actually increase the penetration of any active ingredients you may be using, like retinol, she says. “So ingredients you might have tolerated on adaily basis may now be more appropriate to use only every few days.” (The classic signs of irritation are itching, burning, redness, flaking and dryness.)

If your skin care was part of the problem, you should expect to see your skin calm in seven to10 days. If it continues to get worse and is uncomfortable, then it’s worth getting a medical consultation to make sure you can get a specific diagnosis and discuss targeted treatment, like anti-inflammatories for rosacea.

Now, it’s also important to ensure the fit of your mask is correct so you’re not getting abrasions or pressure sores. Unless you’re specifically required to wear medical-grade PPE, your mask should simply cover your nose and mouth without gaps and lie gently on your skin without compressing the area. “Sometimes people’s masks are simply too tight and they just need a larger mask,” says Abdulla.

As well, you’re absolutely right that masks need to be washed after every wear, but you might also want to consider changing your mask regularly throughout the day, whenever it gets damp. (As I learned with my son, that can be a lot more than once a day.)

“Humidity can definitely be a challenge. Hopefully now that the weather is transitioning, it will be a little bit easier to tolerate, but try to find safe opportunities to take off your mask whenever possible and let your skin dry,” says Abdulla. (Remember to wash your hands before and after taking it off!) And then throw on a clean mask, if you can.

The stress of this whole prolonged situation alone is enough to give most of us a rash, I know. But if we continue to focus on taking care of others, like you’re doing, we will get through it. We’ll just have to keeping trying to get a handle on the hacks that help us deal with the inevitable bumps along the way as smoothly as possible.