Facemask Dermatitis: Symptoms and Solutions

Given that more of the public has been asked or required to wear a mask in the workplace or in public settings, resulting skin problems and rashes has been a common occurrence that dermatologists have increasingly seen in their practice.

Acne Mechanica

“Acne mechanica” is a type of acne that is induced by having a face covering or facemask. This variant of acne is also commonly observed in athletes who wear helmets and is caused by a blockage of the pilosebaceous units that eventually lead to a “pimple” or comedone, the hallmark lesion of acne.

Treatment Tip: Vary the kinds of masks used and use those with breathable fabric. It may also be smart to incorporate an acne treatment regimen such as benzoyl peroxide washes or topical retinoids; however, these may take months to work and often don't address the root of the problem.

Similarly, humidity and heat caused by thick fabrics sometimes used to make face masks may lead to redness, increased telangiectasias and aggravate symptoms of rosacea.

Treatment Tip: Use a face mask made of light, breathable fabric such as cotton and instruct patients to periodically cool down their face throughout the day.

In a positive light, as the COVID-19 pandemic winds down, acne mechanica should improve or gradually decrease as the time in which a mask is worn decreases. Patients who are prone to breakouts or who suffer from severe acne should follow up with their dermatologist.

Irritant Contact Dermatitis

Face masks may also contribute to dry, itchy skin and peeling, features of irritant contact dermatitis. These patients would benefit from a gentle cleanser and regular moisturizing creams for skin hydration to keep the skin barrier intact. Many cleansing agents such as Clorox, sanitizing or baby wipes contain ingredients with alcohol, which burns, stings and contributes to skin peeling and irritation.

Treatment Tip: Have patients avoid anti-aging products while using face masks, which can further aggravate the skin, causing it to crack and peel.

In worse case scenarios, irritant contact dermatitis can lead to post-inflammatory pigmentary alteration, which can occur due to friction, rashes or excessively irritated skin. Usually this will resolve with time.

Treatment Tip: Itchy symptoms can be treated with a topical steroid, and by switching face masks to those with gentle, light and breathable fabrics.

NOTE: Be sure that allergic reactions are not due to metals, rubbers, glues and formaldehydes in face masks.

Friction

Other skin issues that may occur are sores on the nose or posterior ears due to rubbing.

Treatment Tip: Applying a skin barrier such as DuoDERM or silicone sheets can help to reduce friction and reduce skin breakdown, helping the mask ear loops slide easily. Vaseline and petrolatum barrier creams also help to restore the skin barrier, reduce friction and prevent water loss.

Allergic Contact Dermatitis

Last but not least, some patients may develop hives or a true allergy — leading to allergic contact dermatitis — from the mask materials themselves, the rubber components used in the elastic materials or the materials used to clean the masks. Some masks, such as N95 masks, undergo a rigorous cleaning process with ultraviolet light or a chemical process that is sometimes associated with a foul smell from the cleaning and sterilization process.

Itchy rashes may also be related to the associated frequent wet-to-dry situations, like sweating and breathing into the mask followed by the rapid evaporation of moisture when removing the mask, which causes irritation. They can also be due to the rigorous sterilization or cleaning process of masks, such as N95s.

While a rash which occurs in the same location may be an indicator for allergic contact dermatitis, in most cases the skin is simply irritated and symptomatic relief can be provided without the need for further testing. Patch testing can be used to show a reaction in a preservative used in the sterilization procedure for medical instruments or face masks, particularly since the sterilization method is widely used. While most textiles are encouraged to be formaldehyde-free, there are still formaldehyde-containing resins in certain textiles which can provoke an allergic contact dermatitis.

Treatment tip: Every time you remove a mask, apply a good moisturizing cream or petroleum-based ointment to restore the skin barrier. For itchy skin, a mild topical steroid cream can also be applied for a limited time over a couple weeks.

Hand dermatitis from frequent hand washing or wearing gloves is also a common occurrence due to the COVID-19 pandemic. These patients can benefit from patting their skin dry after washing, applying a thick or heavy moisturizer after each wash, a topical steroid cream for eczema or itching and using cotton gloves to retain moisture and medication in the area.

Regular skin hydration with a moisturizer for the face or hands is necessary and recommended to prevent recurrence and worsening of eczema or contact dermatitis, especially after each episode of hand washing or cleansing.

References:

Foo CC, Goon AT, Leow YH, Goh CL. Adverse skin reactions to personal protective equipment against severe acute respiratory syndrome—a descriptive study in Singapore. Contact Dermatitis. 2006;55(5):291‐294.

Donovan J, Skotnicki-Grant S. Allergic contact dermatitis from formaldehyde textile resins in surgical uniforms and nonwoven textile masks. Dermatitis. 2007;18(1):40‐44.

Feinstein A, Sofer E. Mask dermatitis. Int J Dermatol. 1991;30(12):897.

Komericki P, Szolar-Platzer C, Kränke B, Aberer W. Face dermatitis from contaminants on a mask for anesthesia. Br J Dermatol. 2000;142(1):163‐165.

Iwata M, Tanizaki H, Fujii H, et al. Contact urticaria due to a face mask coated with disinfectant liquid spray. Acta Derm Venereol. 2015;95(5):628‐629.