Masking the problem

DR STEVEN LAND

Dr Steven Land has 19 years’ experience specialising in emergency medicine. He launched novellus aesthetics, a multi award-winning clinic in newcastle-Upon-Tyne, seven years ago. Dr Land recently established novellus Training academy to provide a platform to share his expertise and train fellow medical professionals to perform cosmetic procedures at the highest standard. It will launch early 2021.

Face masks are here to stay a while longer, but while they help protect us from coronavirus, they are causing a problem for many: maskne.

Maskne is becoming a lot more common and will continue to be a problem for our patients for the foreseeable future. Our understanding of the condition is largely observational, but the main causes are likely to be the friction from the mask itself and the warm, moist micro-environment that it promotes behind the mask. This microbiome dysbiosis is the perfect environment for acne – excess oil production; a warm, moist environment; pores blocked by make-up and debris, and irritated, inflamed skin.

Increased duration of mask wearing and warm environments are likely to increase the risk of developing maskne.

Acne Mechanica This condition is a direct result of the skin irritation formed by the excess pressure, heat and constant rubbing of the mask against the skin, causing inflammation.

Contact dermatitis Some mask-wearers will experience an allergic reaction to the mask itself.

Rosacea The heat and sweating under a mask can trigger rosacea-prone skin to flare.

Xeroderma Conversely, you may find that constant wearing of a face mask can absorb the natural moisture from the skin, drying out the area. This leaves the skin with a scaly appearance, causing inflammation and discomfort.

PREVENTION

At our clinic Novellus Aesthetics in Newcastle, we are seeing an emergence of patients requesting skin consultations to address maskne, as they find themselves, and their self-confidence, suffering. The obvious first step is to look at prevention. Most of these steps are easy and simple for your patients:

1. Optimise your mask – Encourage the wearing of lightweight, natural fabrics that are less likely to irritate the skin and cause less friction, such as cotton or silk. Wearing a mask that is correctly fitted will reduce friction, and they should remove the mask when it is not necessary

2. Wash your mask – Regular rotation and washing of masks will reduce bacterial contamination and physical dirt coming into contact with the skin

3. Cleanse – Washing regularly with a salicylic face wash will help reduce inflammation and remove older epidermal cells, unblocking pores and allowing for a more normal skin environment. Glycolic acid for further exfoliation if required. If this is their first venture into active skincare, we would advise to start gently though, to avoid further irritating already inflamed skin

4. Make-up free – Encourage patients to either ditch or lighten up on make-up to reduce the physical blocking of pores.

5. Skincare – Irritated, inflamed skin is going to need its barrier looking after. Avoid physical exfoliants – the mask is doing that for you. Reaching for hardcore, super-active products when skin is already irritated is going to exacerbate the problem. Topicals with active ingredients to help treat acne include niacinamide or B6, which help improve the skin’s structure and hydration by strengthening its barrier function and reducing sebum production. We also advise our patients to only use products that are non-comedogenic, as these have been formulated not to clog pores. Hydrating overnight creams and sheet masks will also help keep skin nourished.

REFERENCES

1. Dawson Annelise L, Dellavalle Robert P. Acne vulgaris BMJ 2013; 346 :f2634

2. Botros PA, Tsai G, Pujalte GG. Evaluation and Management of Acne. Prim Care. 2015 Dec;42(4):465-71. doi: 10.1016/j. pop.2015.07.007. Epub 2015 Oct 23. PMID: 26612368.

3. Kanwar IL, Haider T, Kumari A, Dubey S, Jain P, Soni V. Models for acne: A comprehensive study. Drug Discov Ther. 2018;12(6):329-340. doi: 10.5582/ ddt.2018.01079. PMID: 30674767.

4. Fox L, Csongradi C, Aucamp M, du Plessis J, Gerber M. Treatment Modalities for Acne. Molecules. 2016;21(8):1063. Published 2016 Aug 13. doi:10.3390/ molecules21081063

TREATING MASKNE

If the above preventative steps have failed and maskne strikes, then there are a number of in-clinic and at-home treatments that can help our patients.

1. Topical products – Benzyl peroxide is useful for individual spots. It is a non-antibiotic antimicrobial agent that has bactericidal effects by generating reactive oxygen species within the follicle.

Topical retinoids are vitamin A derivatives that normalise keratinocyte desquamation and adhesion, leading to comedolysis and preventing formation of new microcomedones. Some retinoids also display anti-inflammatory properties and have now become a mainstay in the fight against acne.

Starting these treatments when the skin is irritated can make things worse, so they should be used with care.

2. Spot patches – There are many new “pimple patches” on the market that can be used on individual spots. These hydrocolloid patches adhere directly to the problem area, protecting it from further irritation and dirt or bacteria while speeding up healing time.

3. Microneedling/microinfusion – Our Angel Infusion treatment is a new micro-infusion facial and multi-stage facial performed in clinic which combines the benefits of microneedling and mesotherapy in one. This allows a huge increase in the uptake of the products into the epidermis, making it particularly beneficial for maskne. The bespoke, tailored treatment utilises a brand new device exclusive to Novellus in the UK and can also be used for scars, fine lines and wrinkles, pigmentation and dull skin as well as boosting collagen synthesis.