What to Do About Maskne

woman examining maskne in a mirrorPandemic life comes with a lot of things to deal with that we’ve never had to think about before. One of those things is “maskne,” or acne around the mouth and nose caused by wearing masks for prolonged periods of time.

Before we get into the causes and solutions, let me point out that this article is here to offer possible solutions for people who are dealing with mask-related acne. I won’t be addressing whether masks are warranted or recommended or any of that – you’d be better off discussing that with a virologist or immunologist. Not me. This article is for people who have to wear or choose to wear masks, and want to address skin irritation that may have cropped up because of them. 

So let’s get to it. Let’s try to figure out some solutions to this new and growing problem.

First of all, what is maskne?

The technical term for maskne is acne mechanica — clogged pores and pimples caused by friction and rubbing. Before this past year, most acne mechanica was caused by wearing sports equipment, bras, goggles, belts, and other things worn tight against the skin. All that changed with the pandemic. Never before in the history of the world had normal people been asked to affix masks over their nose and mouth for the majority of the day. Not only that, but often the same mask that you hastily dug out of your pockets, still greasy from the last time you wore it.

The big problem with tackling maskne is that it’s a new kind of acne mechanica (before mask-wearing became widespread, most cases were on other areas of the body) and the only research specifically geared toward it is observational. There are no controlled trials. There is just a flood of anecdotes that clinicians and researchers are wading through.

What can you do about it?

Try different masks.

Maskne is more than the friction. It can also be an immune reaction to the mask material. It’s also the lack of oxygen, the lack of air flow, the moisture build-up, the bacterial load accumulating. Different masks have different issues.

N95 masks are tight against the face and restrict air flow (by design). Things get hot and humid in there, and where the actual mask makes contact with your skin, the pressure is great enough to leave welts or bruises and stimulate true acne mechanica.

Disposable surgical masks aren’t as tight, but they’re tight and impermeable enough to create issues.

Cloth masks let air flow, for better or worse, but they also accumulate a lot of grease, grime, and bacteria.

Silk masks are also much easier on the skin, but their ability to filter viral particles is questionable at best.

Point being: all masks are potentially an issue. Try different types made from different material to figure out the issue.

 

Take frequent mask breaks.

Sometimes you have to wear the mask. Sometimes there’s just no getting around it, whether because of safety indoors or rules you must follow. If that’s the case, do your best to take breaks as often as possible. The American Academy of Dermatology Association recommends a 15 minute break every 4 hours, which is woefully inadequate in my opinion. Better is as often as you can.

Maybe it means pulling the mask down when there’s no one around or stepping outside to take an extended mask-free break.

Handle the basics.

Acne is ultimately an inflammatory condition. While mechanical maskne isn’t quite the same as hormonal or “internal” acne, it’s a safe bet to assume that you should at least shore up all the things that have shown to affect the latter.

Eat plenty of zinc (red meat, oysters, organ meats).

Get enough omega-3s: EPA (a long chain omega 3 found in marine foods) is usually lower in people with acne.1 Eat fish or take fish oil.

Control your insulin: Since insulin can stimulate IGF-1 production, which in turn increases sebum production in the skin, chronically high insulin levels can cause clogged pores. Recent studies done during the COVID pandemic have found that acne and other inflammatory skin conditions are worse in patients with insulin resistance.2 Funny how insulin keeps popping up, eh?

Try a mask bracket.

A mask bracket is a small accessory worn on the inside of your mask that creates airspace between your skin and the cloth. It may be just what you need to reduce friction and help with airflow near your mouth and chin, where mask-related breakouts are likely to occur.

Take sun breaks, take vitamin D.

A traditional treatment for acne was UV therapy, which was discontinued after dermatologists determined it to be “more harm than it was worth.” That’s nonsense, of course, as long as you’re getting natural “UV therapy” by actually being out in the sun. Furthermore, vitamin D plays an integral role in skin inflammation, so if it’s your only option taking supplements will help.

But actual midday sunlight on your face and body is ideal and will almost certainly improve maskne.

Remember: being cooped up inside has been terrible for our collective vitamin D levels. Is it truly just a maskne epidemic, or is it a sun deficiency epidemic?

Change and launder your masks.

If you have to wear a mask for a prolonged period of time, change to a clean mask part-way through the day. Remember to wash your cloth masks as often as you would wash your clothes, instead of storing it in the cupholder of your car between uses. And use fragrance-free, eco-friendly detergents to avoid irritation that’s caused by cleaning agents and scents.

Avoid or limit harsh facial products.

Alcoholic aftershaves, chemical peels, acne treatments that dry the hell out of your skin, exfoliants, salicylic acid—these products are made with the mask-less face in mind. They likely weren’t tested on people wearing a tight-fitting, nearly-airtight mask for half the day. It’s a whole new world out there.

Avocado oil with tea tree oil.

Blend a couple tablespoons of avocado oil and two tablespoons of MCT oil with some tea tree oil. Start low with the tea tree oil and slowly titrate up to confirm your skin can handle it. The avocado oil is good for your skin (and can even speed up the healing process), the MCT oil is anti-fungal and anti-bacterial, and the tea tree oil is effective against the acne-causing bacteria (even compared to pharmaceuticals)3. Don’t slather it on, though. You don’t want to get oily. A few drops rubbed into your face before and after mask-wearing will do the trick.

Put bacteria on your face.

Not all bacteria are bad. Just like our guts, mouths, and even nasal cavities have microbiomes, our skin has a microbiome—a colony of beneficial bacteria serving a vital role. As a recent letter to the editor regarding COVID-related maskne suggested, maskne-prone skin probably has a dysfunctional or unbalanced microbiome, and regular acne-prone skin definitely has lower levels of ammonia-degrading bacteria.4 Enter Mother Dirt, the probiotic skin spray that colonizes your skin with the ammonia-degrading bacteria that acne-prone skin is missing. Ammonia-degrading bacteria can modulate the skin’s immune environment, potentially nullifying the formation of acne.

Mother Dirt hasn’t been formally studied in the treatment of maskne, but it’s worth trying. Can’t see it hurting.

Nasal breathing (or mouthwash).

One ancedotal fix for maskne I’ve seen around the Internet is using mouthwash before donning your mask. Reason being, this kills the bacteria in your mouth and prevents you from contaminating the inside of your mask with it through constant mouth-breathing. Maybe that’s true. Maybe it’s not.

Instead of mouthwash, why not try exclusive nasal breathing? It’s healthier, anyway, and it may even improve your ability to fight off potential COVID viral particles.5 And you won’t be breathing out oral bacteria all day long.

(Mouthwash might be worth a shot, too)

Chew gum.

If the “breathing bacteria into your mask” hypothesis is true, then chewing gum while wearing a mask should also improve maskne by promoting nasal breathing and reducing pathogenic bacteria in the mouth.

Xylitol gum will help reduce bacteria.

Don’t wear makeup under your mask.

Makeup is designed to be worn in open air. You know, where it can be seen. Wearing a mask over makeup just pushes it deep into the pores, promoting clogs and the formation of acne.

What’s the point, anyway, if no one can see it?

Only wear the mask when necessary.

I may get guff for this, but here goes: I have not seen much evidence that suggests that going mask-less outdoors in an open space is particularly risky. If you have evidence to the contrary, feel free to leave a link to the medical literature in the comments. Sure, if you’re shoulder to shoulder in a crowd, wear a mask. Sure, if you’re face to face with someone whose immunological status you can’t confirm for a long conversation, wear a mask. If you’re in an area where mask-wearing is mandatory outside, like a zoo or theme park, follow the guidelines. But in the vast majority of outdoor situations, going mask-less is fine. Hiking? Don’t need it. Briefly passing by someone on the sidewalk? Don’t need it. A study out of Italy (one of the areas hardest hit by COVID) found that “outdoor air in residential and urban environments was generally not infectious and safe for the public.”6

If you must wear the mask outdoors on pain of death or imminent prosecution, wear the mask. If it’s a matter of showing respect and making people feel safe, I get that. But as far as infection risk, from what I gather it is very low.

But this has to be the first line of defense because the mask is the proximate cause of the acne. Limit the mask-wearing only to when you must wear it and you will limit the amount of friction and irritation applied to your face.

What about dedicated acne products?

I’m sure there are other products out there. A quick search of Youtube produces hundreds of beauty anecdotes from people who used baby shampoo or dandruff shampoo or a pharmaceutical formulation to fix their acne, but there’s no way to vet those. Taking more “natural” steps and replacing the lost bacteria that protects against other kinds of acne seems like the most evolutionarily-congruent path.

Look: you could go to a dermatologist (in your mask) and come home with a sack of pharmaceuticals. Maybe that would work. Maybe that’s a last resort. But I’d highly recommend that you do the best to attack the problem at its fundamental core.

I’d love to hear from you folks. What’s worked against maskne? What hasn’t? What’s made it worse?

Take care, everyone. Be safe out there.

About the Author

Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.

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22 thoughts on “What to Do About Maskne”

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  1. Thankfully I only have to wear a mask at work in the hallways. My workspace is usually empty of people except one comes in now and then, so no mask most of the day. As soon as I get outside off it comes. Cracks me up when I see people driving in their car ALONE and wearing one. I believe that walking outside without my mask is allowing my immune system to work and get stronger, that’s my 2 cents.

    1. Like you, I am fortunate to only have to wear my mask while out in our store with other people. Typically when I work in the office (most of the time); I only wear it when the “older employees” come in, as they seem to be unduly fearful and paranoid. I absolutely DETEST the damn things, and only wear one when I must. It’s pitiful when I see people walking, jogging, etc. wearing one …. and as you mentioned, in their cars ALONE.

    2. To give you a different perspective as to why people wear a mask in the car: My apartment building requires that people wear a mask in common areas (hallways, stairwells, sidewalks). So if I wear my mask to my car, sometimes I don’t bother to take it off. In addition, if people are running errands and making several stops, they might just leave it on.

  2. I have a question for MDA staff:
    How long does it take to moderate a comment? This is the second time I am asking this question, and it is the second comment in two weeks that got a message about being moderated, and then the comment was never published. My comment on higher education article did not contain any offensive content; yet it simply disappeared and was never published. The comment on maskne is also not being published. When I tried to submit it again, it said that it was a duplicate comment. Please help me understand the process of comment publication.

    1. “Awaiting moderation” is a euphemism. In reality it means the comment will get dumped. I get this every now and then, for whatever unknown reason, and none of those comments ever got posted.

  3. I would be careful about using avocado oil on oily, acne-prone skin. It’s probably fine for dry to normal skin types, but it can clog your pores if you already have a problem with that. Argan oil (with a comedogenic classification of 0) might be a better choice. Personally, I use shea butter as a facial moisturizer. It’s non-greasy and has the ability to normalizes natural oil production.

  4. What to do about maskne? Since it has been amply demonstrated that masks only cause worse health, even in surgical settings, there is absolutely no reason to wear one outside of actual smoke, dust, solvent etc. settings. So, just don’t. Problem solved.

    1. Yes, there is a medical reason to not wear a mask. And every mask mandate allows for medical exemptions. It can be stressful to have to explain to store employees and others all the time, but if it’s what you feel is right, do it.

      1. True. We were given nostrils for a reason! Personal distress is sufficient reason to claim exemption in the UK. Outside of technical masks in surgical settings, or if you’re coughing and sneezing (stay home in bed please) the homemade cloth ones are just for show and reassurance for a public that has been scared witless and out of all proportion.

    2. Can you elaborate on the statement that masks only worsen health problems? Very interesting to say during a pandemic in which masks have been proven to save lives. (Sources: Lyu 2020, BMJ 2020;369). I am seeing that face masks are 5 fold more effective at protecting you from the virus than not wearing one.

      What clinical studies are you getting your data from? Anecdotally, I work in a center center and I can only imagine the thousand + lives (in just our hospital alone) that have been saved from all staff and employees wearing mask during the SARS-CoV-2 outbreak. Curious where you got the knowledge to make that statement. Google PubMed and COVID face masks. When you get to an article you want to read press the Full Text button.

      And Mark, why would you ever have to address whether or not masks are warranted or recommended? 2.62 million deaths globally from a novel virus in one year, but nbd y’all.

      1. Thank you, Mackenzie.
        Really disappointed in the tone of the comments here.

  5. TLDR: Here’s an idea: Masks don’t work to slow the spread and cause more harm than good. Stop wearing masks.

    1. Please provide a single clinical study to prove this. I’m on pub med now! Not seeing any, how odd!

      <3 a health professional who can’t believe she is reading this

    2. Yes, please don’t spread misinformation online. You are repeating “political statements”, not medical facts.

  6. I’ve honestly never had an issue, or have never met someone with this. In Japan, masks are very prevalent, especially between November and May during the flu and Hay Fever season. I wear a mask every day, all day for 8-9 hours a day, and only take it off to eat or take a drink of something. It’s a small price to pay to remain safe and healthy. On the bright side, wearing a mask reminds me to breathe through my nose more.

  7. Sad that this is an issue at all. I live in Sweden where we havent had masks at all for the last year and we are no worse of than other countries in Europe despite what you might hear on the news. Life has continued much as before with no apocalypse even if we havent worn masks.
    I guess what I missed in the article was the argument of refusing the mask altogether whenever possible. They dont work and probably do more harm than good, also on a psychological level.
    Something that comes to mind when reading this article is, if it suits everyone it doesnt suit anyone.
    Really love Marks Daily Apple though and everything Mark does