Wearing masks can trigger skin conditions
Experts explore other skin conditions that could be the problem, and their treatments
Back in the summer, we saw a rash of stories about maskne, a form of acne caused by masks rubbing our skin and characterized by pimples on the lower face.
But dermatologists have spotted a problem: Skin conditions that to the untrained eye look just like acne and might be made worse by masks, but need very different treatment.
“Acne, perioral dermatitis and rosacea can all present as small red bumps on the face, especially around the mouth and nose, sometimes with pus bumps or pustules,” says Dr. Aegean Chan, a dermatologist based in California. “I have definitely seen an increase in both perioral dermatitis and rosacea during the pandemic, and many colleagues have reported the same. I think it's multifactorial. The biggest lifestyle difference is mask-wearing. When you're wearing a mask you have occlusion of the skin, increased heat and trapped moisture. These are triggers for both conditions, particularly rosacea.”
Dr. Chan suggests that friction from masks can damage the moisture barrier — the outermost layer of skin that keeps water in and aggressors out — which can also predispose people to flares of rosacea and perioral dermatitis. On top of that, there's stress and increased alcohol consumption, both of which can exacerbate skin conditions.
Vancouver dermatologist Dr. Shannon Humphrey says there are some key differences between acne, rosacea and perioral dermatitis if you know what you're looking for.
The zits with rosacea and perioral dermatitis tend to be uniform whereas with acne, there are typically different types, such as blackheads, whiteheads and papules. Rosacea is a chronic genetic condition that can often cause flushing or overall redness, and it typically appears in people with Scandinavian and Celtic backgrounds — fair skin and blue eyes.
“With perioral dermatitis, skin feels burny and irritated,” Dr. Humphrey says. “Technically maskne is along the chin prominence where the mask would be rubbing whereas perioral dermatitis is right around the mouth.”
What happens if you do mistakenly treat perioral dermatitis or rosacea as if it was acne?
“Both are characterized by hypersensitivity to irritating products, so all the things you reach for first when you think it's acne, like salicylic acid, benzoyl peroxide and retinoids, are problematic,” says Dr. Chan. “Steroids improve most dermatological conditions, but they can actually cause flares of rosacea and perioral dermatitis. A common pattern is that people use steroids, notice their rash has improved for a couple of days, and then it gets much worse.”
Both doctors agree that seeing a dermatologist is the best way to address either rosacea or perioral dermatitis. That will give you an accurate diagnosis and also allow you to access effective treatments such as prescription-only topical and oral antibiotics, and non-steroidal anti-inflammatory creams.
“It's frustrating to see people who have been suffering for months and trying dozens of things when it's something we can help with,” says Dr. Chan.
That said, many people are reluctant to make what they deem non-essential trips to the doctor, or they don't have access to a dermatologist. In those circumstances, what are the first steps?
Dr. Humphrey says while perioral dermatitis is ill understood, people who use lots of beauty products are more likely to get it, so it may be time to ditch that 20-step Korean skin care regimen.
“Stripping back the skin care is a thoughtful and rational approach,” she says. “Take it back to bare bones — a gentle cleanser like Cetaphil or Cerave, a fragrance-free moisturizer and sun protection. It makes sense to use as few skin care products as possible, but if you want to wear makeup, mineral is the least irritating. There's also a connection between fluoridated toothpaste and perioral dermatitis.
Dr. Chan says around 50 per cent of her patients notice an improvement when they switch to a non-fluoridated variety. She also believes keeping a diary of possible triggers for skin conditions can be helpful, particularly in rosacea where it varies from person to person and the triggers include everything from alcohol to exercise.
As to more fundamental lifestyle changes for people who feel as if they've tried everything, Dr. Humphrey says diet is a fascinating frontier.
“At the cutting edge of rosacea research is understanding the gut/ brain/skin axis,” she says. “The idea is that gut health and a healthy gut microbiome is necessary for general health, and conversely, an unhealthy gut microbiome may be linked to systemic inflammation in conditions like rosacea.”
When it comes to skin care, people with perioral dermatitis and rosacea aren't necessarily confined to safe-but-dull moisturizers. Even though rosacea is chronic and characterized by extreme sensitivity, there are also options to explore. Dr. Chan says if skin is not actively flaring, people can try new skin care on a small area for a few days to see if their skin can tolerate it.
“Gentle AHAS at lower percentages, like lactic or mandelic acid, are probably good ones to start with,” she says, and she believes enzyme exfoliants are gentle and will still deliver a glow. A new ingredient to try that you probably haven't heard of is azelaic acid.
“It is a great option for brightening and lightening,” Dr. Chan says.
The biggest plus? It's actually good for treating rosacea, so you can treat your skin as you boost your glow.