Case Report: Facial Mask Induced Acne ("Maskne")

¹Clinical Preceptor, Temple University School of Pharmacy, Philadelphia, PA, USA

²Department of Emergency Medicine, Jefferson NJ, Stratford, NJ USA

³Alan Lucerna DO, Program Director, Emergency Medicine Residency, Department of Emergency Medicine, Rowan University SOM, Jefferson Health New Jersey, Stratford, NJ, USA

*Corresponding Author: James Espinosa MD, Department of Emergency Medicine, Rowan University SOM/Jefferson, 18 East Laurel Road, Stratford, NJ 08084, USA; Email: [email protected]

Received Date: June 24, 2023

Publication Date: July 15, 2023

Citation: Meister G, Espinosa J, Lucerna A. (2023). Case Report Facial Mask Induced Acne ("Maskne"). Mathews J Emergency Med. 8(5):65.

Copyright: Meister G, et al. © (2023)

ABSTRACT

A 42-year-old male health care worker presented with complaints of severe mask-related acne vulgaris predominately to the cheeks, chin and nose. Mask-related acne and acne-like eruptions have been referred to as “maskne” in the lay press and on social media. The patient stated that his current position required the use of an N95 respirator to be worn throughout his shifts. His shift lengths ranged from 9-14 hours, 6 days per week. N95 and surgical facial mask use has been a requirement for many occupations during the COVID-19 pandemic. The acne vulgaris onset began after the use of the mask. The acne would improve on vacations and time away from work and would recur within hours of returning to work with associated mask use.  Extended daily use of such masks may lead to changes in the skin which can induce irritation and precipitate infection. This has been called “maskne” in the lay press.

Keywords: Maskne, Mask-induced acne, acne vulgaris, healthcare workers and COVID-19

INTRODUCTION

A survey found that about 50 percent of patients who used facial masks experienced pruritus and erythema, with longer times of face mask or goggle use associated with two times higher odds of skin damage [1].

Mask-related acne has been referred to as “maskne” in the lay press and on social media [2].  Several factors have been discussed during the pandemic to explain the causality of increased facial acne amongst health care workers. Possible mechanisms of maskne include follicular plugging from trapped oils and altered skin flora subsequent to prolonged cutaneous occlusion [2].

CASE PRESENTATION

A 42-year-old male health care worker presented with complaints of severe mask-related acne vulgaris predominately to the cheeks, chin and nose. His work required the use of an N95 respirator to be worn throughout his shifts, which ranged in length from 9-14 hours, 6 days per week. The patient stated that prior to his mask use he had a pre-existing diagnosis of recurring acne vulgaris usually treated with a 2-4 week course of Doxycycline 100 mg twice daily. Upon remission they were then well-controlled, with occasional re-occurrence, through the use of over-the-counter products and sparring use of a topical retinoid. He had no episodes of acne vulgaris for several years prior to the mask use Since mask use patient states that flares of erythema and acneiform eruptions were refractory to the use of over-the-counter benzoyl peroxide 10% cleanser, adapalene gel 0.1% and bi-weekly applications of tretinoin 0.05% cream. The acne would improve on vacations and time away from work and would recur within hours of returning to work with associated mask use.  A periodic four week course of Doxycyline 100 mg bid improved the acne.

DISCUSSION

FFP2/KN95 masks are greater risk factors for the development of acne than surgical masks because of their higher humidity, occlusion, and temperature [2].  Skin microbiota is influenced by genetic and external factors such as environment, pH, and temperature, all of which are modified with mask‐wearing and retention of biofluids [3].  Mask‐wearing potentially introduces a “new” intertriginous area which is susceptible to similar infections, in particular with microbial communities like Staphylococcus and Corynebacterium, which favor moist regions [3,4].  N95 respirator and surgical masks are associated with transepidermal water loss (TEWL) and increased sebum production in the area covered by the mask. These changes persisted even after mask removal in the case of N95 respirators [4].  This has been called “maskne” in the lay press.

Suggested general preventive measures include 1) daily changing of masks; 2) avoidance of occlusive substances like oil- or petrolatum-based emollients or cosmetic products; 3) use of a mild non-soap-based cleanser for facial cleansing; and 4) regular break times with removal of masks for 15 minutes every four hours in a socially distant space, such as outdoors or in one’s own car [5].

Since specific guidelines for the treatment of “maskne” do not exist, instructions are taken from acne vulgaris therapies [6]. Mild acne should be treated with topical products; a combination of topical agents or an association between topical and systemic therapies is suggested for moderate acne, while severe forms usually require both systemic and topical therapies [7].

Systemic antibiotic use can be considered in patients presenting with severe mask induced acne refractory to the use of multiple topical agents. Oral antibiotics improve inflammatory lesions by inhibiting the growth of C. acnes within the pilosebaceous units [8].

In order to avoid bacterial resistance, treatments are limited to continuous therapy for three to four months [8].

CONCLUSIONS

Extended daily use of occlusive masks, such as the N95 respirator, can induce changes in the skin leading to irritation and infection. N95 and surgical facial mask use has been a requirement for many occupations during the COVID-19 pandemic. Newer masks should be designed with the goal of reducing facial infection and eruptions of acne vulgaris.

CONFLICTS OF INTEREST

The authors declare that they have no conflicts of interest. There was no funding for this research.

REFERENCES

1. Lan J, Song Z, Miao X, Li H, Li Y, Dong L, et al. (2020). Skin damage among health care workers managing coronavirus disease-2019. J Am Acad Dermatol. 82(5):1215-1216.
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3. Teo WL. (2021). The "Maskne" microbiome - pathophysiology and therapeutics. Int J Dermatol. 60(7):799-809.
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