The tendency of the fabric mask to alleviate or trigger the dermatological disease
Acne, perioral dermatitis, seborrheic dermatitis, eczema, and rosacea are some of the common skin conditions that will be worsened by the wearing of a face mask. The reason is due to the occlusive microenvironment increasing the growth of bacteria and yeast, as well as the friction causing skin discomfort which can trigger off inflammation in individuals with pre-existing dermatological conditions. All fabrics will reduce the ventilation around the area of the skin covered by the mask, and this will increase heat and moisture, factors that promote microorganism growth. When it comes to maskne prevention, these are important factors to consider.
How functional textiles can help balance the “germs” required in maintaining skin health
What is the skin microbiome?
The term microbiome refers to the balance of germs-bacteria, viruses, fungi, mites, that work with our body to keep it healthy. These germs have to be present for our immune system to work and self-regulate. It is formed at birth, changes as one age, varying in terms of each location i.e. the germs on our scalp are vastly different from that in our oral cavity, our nose, and the rest of the skin. Various dermatological conditions have now been shown to be linked to microbiome dysbiosis, which relates to an imbalance in the skin flora.
Acne patients, for example, are colonized with propionibacterium acnes, and the latest research shows the link between a new type of bacteria known as C.acnes, on the skin of sufferers. Seborrheic dermatitis, a flaky condition that can affect the eyebrows, the nasolabial folds, around the nose area, and the scalp, is linked to an overgrowth of a yeast organism known as Malassezia furfur, which favors oily, moist and humid environments. Eczema is linked to staphylococcus aureus colonization, which drives a superantigen effect that causes inflammation in eczema patients.
Functional biotextiles in dermatology, such as those impregnated with silver, zinc, or copper ions, have been proven to have biocidal effects i.e. inhibiting or killing off microorganisms upon skin contact. These have been used to treat fungal and bacterial infections, as well as an adjunct therapy in the treatment of eczema. Such textiles hold potential for the treatment of maskne, and help in maskne prevention because of its effects on the microbiome and may reduce the risk of antibiotic resistance in individuals being treated for maskne.
The CUIONS™ Copper Silk Face Mask has been laboratory tested to kill Staphylococcus Aureus, a common bacteria that can cause secondary skin infections in acne and worsening of facial eczema. Bacterial/Fungal infections can cause maskne, making the mask ideal for maskne prevention. The surface is also water/splash resistant with adjustable ear loops.
The copper nanoparticle mask is clinically proven to be more hygienic than the standard fabric mask. It has anti-odor properties with the copper ions killing bacteria/fungi/microbes that come into contact with the mask. This is particularly suited for comfortable wear against your skin over prolonged periods. Copper impregnation is also backed by clinical studies to have active skincare properties such as anti-wrinkle and anti-ageing, due to stimulation of collagen growth through contact with copper ions actively released on contact with skin. Data from randomised controlled trials demonstrate statistically significant reduction in facial wrinkles after 2 weeks of exposure to copper infused textile.
How the material of fabric masks affect the skin – poor ventilation as a contributing factor
Many would have heard the term “breathable” fabrics being used when discussing the material of face masks and it is appropriate for me to delve further on this topic here for maskne prevention.
Our skin maintains a healthy microenvironment via self-regulation through transepidermal water loss, ceramide skin barrier, and natural moisturizing factors. Most of us are born with healthy skin barriers and the topmost layer also known as stratum corneum where most of the action happens. The health of the stratum corneum is crucial because we are able to produce sufficient amounts of lipids and natural moisturizing factors at the surface of our skin. Our stratum corneum adjusts according to our environment.
Transepidermal water loss increases in dry temperate climates and reduces in humid climates like Singapore. However, there is always a problem that arises when you have a dysregulation of the skin microenvironment. Poor ventilation is a very simplistic way to think about it in terms of what’s going on at the skin barrier but it reduces the evaporation of fluids from the surface of your skin. The fluids refer to your saliva, your nasal secretions, sweat which otherwise will not get in contact with skin. All that creates a new environment that does not allow your skin to breathe. The key concept here is that it is important to maintain a healthy skin microenvironment
Maintaining a healthy skin microenvironment for maskne prevention
Firstly, counteract the negative environment that the facial covering is creating — essentially the increased moisture and heat retention. How do we do that? The type of material matters. We know that there are breathable fabrics and there are non-breathable fabrics. Breathable fabrics would typically be made up of natural plant-derived origins such as silk, cotton, linen. However, these do not wear well and are less durable. They can have the added function of wicking moisture away from your skin which results in increased breathability, but also can retain the moisture within the fabric itself due to low evaporation rates and result in increased discomfort from the weight and stickiness of the fabric.
Synthetic fabrics – polyester, polyurethane derivatives are commonly used as part of surgical masks as well as N95 masks. The reason is that the tight weave of these synthetic fabrics can effectively prevent the transmission of respiratory particles and droplets. However, these are not kind to the skin at all. In fact, polyester creates an even “stuffier” environment and this can increase your chance of getting acne mechanica also known as occlusion acne, and does not help with maskne prevention.
That’s when the concept of breathability becomes important in maskne precention. What exactly is this breathability about? It is the material’s ability to wick moisture away from your skin and to keep it dry. You are constantly breathing in and out and this moisture will accumulate regardless especially when you talk while the fabric is in direct contact with your skin. Our saliva also contains enzymes. In individuals who have prolonged contact with this saliva on their skin, some may develop eczema or dermatitis in addition to mask acne bumps.
The Lyosilk Mask is synthesised to be anti-microbial due to its quick drying and moisture wicking properties. It provides a cooling, sweat-wicking, breathable layer against skin to prevent skin irritation due to prolonged surgical mask wear.
The benefit of natural materials is that it is breathable. Though these are not waterproof, the density of these fibers is often much less than synthetic ones hence reducing the protection to the environment. This reduces the efficacy of the product. Natural fibers would include silk, cotton, linen. In my practice, we have been recommending individuals who have to wear a surgical mask in restaurants and medical settings to use a mask slip.
An example would be the Lyosilk mask slip to use with the surgical mask (derived from 100% plant cellulose fibers). It is very smooth and soft on the skin while wicking away moisture, which leads to increased breathability on your skin. This, however, would mean there is an added layer to the surgical mask, which would increase the heat retentive properties of the mask. For usage in non-healthcare (lower-risk) settings, a reusable fabric mask made of a treated synthetic fabric with increased evaporation coefficient, cooling properties would be ideal for maximum comfort without compromising on the effectiveness of controlling the environmental spread of respiratory droplets.
It is important to maintain a healthy barrier between your skin and the mask to minimize the chance of skin irritation. In this chapter on maskne skincare, we will touch on the fundamentals of the skin microbiome – the balance of good and bad bacteria and yeasts on one’s skin, and the importance of skin care to maintain the microbiome balance.
Maskne skincare recommendations for mask-wearing
The wearing of an occlusive face mask has implications for the absorption of skincare applied. A moist and humid environment increases the absorption of any topical applied to the skin, which in the case of acne treatments, can increase the irritation potential of the active ingredient(s)
When mixed with sweat, certain active ingredients may also be biochemically altered and cause dermatitis (eczema). Sunscreens commonly cause irritation in individuals with eczema, and wearing a chemical sunscreen (as opposed to a physical sunscreen) under occlusion and sweat will increase the chance of developing sensitivity to the sunscreen.
Choice of Cleanser
A gentle emulsifying cleanser is important for thorough cleansing. For individuals who wear makeup, double cleansing is recommended to remove residual sweat, grime, oil, and make-up build-up. For non-acne prone individuals who wish to prevent maskne, it may be time to get started on a gentle cleanser with antibacterial properties.
My personal maskne skincare recommendation is the cleanser from my cosmeceutical line formulated with medical-grade honey. Medical grade purified honey functions as a broad-spectrum antimicrobial with natural emulsifying properties.
Medical grade honey is used in the Miel Honey Cleanser which has natural emulsifying, antibacterial, anti-fungal properties for gentle and effective cleansing in eczema-prone individuals. Natural honey is also a humectant, trapping a layer of moisture for protection after cleansing.
Choice of Acne Cream
When it comes to maskne skincare, avoid acne spot creams with synthetic active ingredients such as retinoids, benzoxyl peroxide, aulfur, salicylic acid as these will cause increased skin irritation (irritant contact dermatitis) when applied under the occlusion of a face mask. Individuals who apply retinoids for night acne treatment may find that wearing a mask in the day increases the risk of retinoid dermatitis, a form of eczema that leads to redness and flaking on the skin.
There are many different formulations of acne creams. The ones that we are familiar with would be benzoyl peroxide, salicylic acid and even sulphur or tea tree oil base formulas. These have largely fallen out of favor in dermatologists in the last 2 years primarily because of irritation potential.
Benzoyl peroxide is also known to bleach fabrics and may alter the structural integrity of the face mask, rendering it less effective for control of droplet spread. Anti-inflammatory acne spot creams are recommended. Acne formulations with botanical actives such as Chlorella Vulgaris work by regulating sebum production, whilst natural moisturizing factors like amino acids fight inflammation and have additional moisturizing properties to protect the skin barrier.
The Blemish Spot Cream is formulated with an algae extract, Chlorella Vulgaris, that reduces the activity of oil glands and has anti-inflammatory properties. Natural Moisturising Factors (NMF) in the form of amino acids help to reduce scarring and promote wound healing of the pimple.
In the ideal maskne skincare routine, hydrocolloid acne patches can be helpful because of the following reasons: 1. Prevents touching or picking which can lead to infection and scarring 2. Creates a moist microenvironment for faster and better healing 3. Increases absorption of active ingredients in pimple cream (non-irritating anti-inflammatory formulas recommended; avoid those with salicylic acid or retinols if you have sensitive skin) 4. Absorbs fluid to aid in quick resolution of acne papule/cyst
Hydrocolloid patches can sometimes contain active ingredients i.e. salicylic acid and benzoyl peroxide, hyaluronic acid and niacinamide, although it can certainly be used on its own with benefits as above. Overall, it helps acne papules heal faster by reducing inflammation.
Use of powder formulations to control excess oil and moisture
Mineral zinc oxide has anti-microbial and oil regulating properties. I currently recommend a loose powder formula for my acne-prone patients, as part of treatment for their oily skin. The benefits of using a zinc oxide powder formula for individuals suffering from maskne are as follows: control of bacteria as zinc oxide is antimicrobial, control of sebum regulation and absorption of excess moisture in those who suffer from hyperhidrosis (excess sweating). In addition, zinc oxide is an inert ingredient which means it is not affected by changes in pH or sweat.
For dry skin: Use protective emollient creams that contain barrier repairing ceramides and humectants such as polyglutamic acid, hyaluronic acid and natural moisturizing factors like amino acids. Avoid urea or lactate based humectants as this will likely cause skin irritation when mixed with sweat on the skin. Avoid occlusives such as white soft paraffin as this may increase the incidence of acne mechanica
The Multi-CERAM Cream is a new generation “Smart Moisturiser” formulated as a Prescription Emollient Device. It is formulated with an optimal skin lipid mixture, containing a mixture of plant-derived phytoceramides and synthetic ceramide. Antioxidants that fight skin inflammation are incorporated for optimal treatment of eczema.
For combination/oily skin: Use serums and emulsions/lotions rather than cream formulas. Cosmeceutical formulations containing plant anti-oxidants like Portulaca Oleracea, Centella Asiatica, Brassica Oleracea are anti-inflammatory and can be helpful in maintaining healthy skin function.
The Radiancé Fluide™ Hydrating Emulsion contains amino acids, oligopeptides and niacinamide for regeneration and skin brightening, specially formulated for a lightweight feel to impart a radiant glow.
The Elixir-V™ Total Recovery Serum is an intensely nourishing concentrate of deep hydrating, lifting and tightening peptides for the perfect V-face look.
Predominant outdoor mask wear in warm, humid climates
A maskne skincare tip would be to use serum or lotion vehicles instead of cream formulas. Choose humectants and emollients instead of occlusives (petroleum jelly, mineral oil-based liquid paraffin). This applies to both dry and combination/oily skin. The occlusive effect of the face mask in combination with a humid climate can lead to worsening of facial eczema and trigger occlusion acne
The Mineral Booster™ is power-packed with amino acids for repair, potent plant root extracts for UV-protection and polyglutamic acid for superior moisture retention.
When it comes to sunscreen as part of the ideal maskne skincare routine, the following issues are of concern here:
1. The oil solvent in sunscreen formulations can be comedogenic and can trigger off flare-ups of conditions such as perioral dermatitis. 2. The chemical sunscreen components (azobenzenes, cinnamates) can cause irritant contact dermatitis, which can be worsened by the occlusive effect of a face mask as well as by sweat accumulation on the skin. 3.The waterproof formula is necessary due to moisture and sweat build up under the face mask and will require frequent reapplication. 4. Reapplication of sunscreen under the face mask throughout the day may not be practical.
When one develops irritation after applying sunscreen, it is often due to chemical sunscreen components mixing with sweat. Some individuals feel stinging whenever they wear sunscreen, and it is usually not because they are allergic to sunscreen itself but it’s simply because the chemical block components can be altered via exposure to UV-light and when mixed with sweat (ammonia content).
The Sun Protector is exquisitely formulated for humid climates. It is a broad-spectrum sunscreen that also regenerates and soothes sensitive skin.
The relevance of UV-protection is not to be undermined. For normally healthy individuals, it is an important step to the prevention of photo-aging and skin cancers. For photosensitive individuals i.e. on acne treatment (retinoids/oral tetracycline), rosacea, lupus, post-laser, it is a key part of dermatological treatment. Sunscreen requirements should include broad-spectrum protection minimum SPF 30+, although the standard in dermatology practices are SPF 50+. Physical sunscreens are preferred over chemical sunscreens due to the inert formula of physical blockers, being less likely to trigger dermatitis.
Fabrics with ultraviolet-protective function (UPF
One part of maskne skincare, is the type of face mask chosen. All fabrics confer some level of protection from ultraviolet light, although for a garment to qualify as ultraviolet protective, there are key requirements, based on the current European guidelines. The design of the garment has to cover a maximal body surface area. Following which, the UPF-rating of the material itself depends on scientific measurements such as fiber chemistry, porosity, concentration, fluorescent whitening agents, UV-absorbers, and other finishing chemicals. While natural fibres such as cotton, silk and linen are breathable, they often confer very minimal to no UV protection. All approved UV-protective garments are synthetic in nature.
Currently, I recommend UV-protective fabrics for fabric masks, as a practical solution for sun protection during the pandemic. UPF 50+ qualifies for excellent protection according to the Skin Cancer Foundation Seal of Recommendation guidelines. A UPF 50 fabric blocks 98 percent of the sun’s rays and allows two percent (1/50th) to penetrate, thus reducing your exposure risk to UVA and UVB radiation, which causes photoaging, pigmentation and skin cancers.
Implications for individuals with skin pigmentation concerns
Given that it is highly recommended to wear a face mask during the COVID pandemic, it may be a turning point in dermatological care for the treatment of pigmentary disorders. Dermatologists are always looking at the topic of sun protection with great interest because firstly, it is the biggest contributor, other than our own genetics, to skin cancer. Secondly, it is the most significant external factor affecting aging, pigmentation disorders such as melasma and solar lentigines (sun spots). Sun protection advice for individuals suffering from facial pigmentation has been traditionally centered on the use of broad-brimmed hats, broad-spectrum sunscreens with minimum SPF 30.
With current recommendations to wear face masks, it is timely to revisit the topic of UV-protective clothing. In countries where there is a culture of sunbathing, there are higher rates of skin cancer, especially in individuals who are of a lighter skin phototype/have light-colored eyes i.e. blue or green eyes. The benefits of UV protective clothing is as such – offers gold standard protection with UPF 50+, not affected by factors such as reapplication (of sunscreen) or water-resistance. Fabrics are conferred with ultra-violet protection properties by way of specific material treatments, and are also required to meet the basic requirements of maximal skin coverage.
In August 2020, Dr. Teo Wan Lin, author of Skincare Bible – Dermatologist’s Tips on Cosmeceutical Skincare, was invited as a guest dermatologist for Clozette’sInstagram live session on the topic of maskne. A prominent researcher in the area of cosmeceutical skincare, Dr. Teo answered questions about acne care, hydrocolloid patches, maskne, and imparted useful tips for skincare routines. Read on to find out more about what Dr. Teo shared with editor Becks Ko and beauty KOL Khaw Xin Lin.
When it comes to choosing skin care products to tackle maskne, should we choose natural ingredients or “chemical” ingredients?
Dr. Teo emphasized that one should focus on whether the ingredient itself is evidence-based. “Some examples of naturally-derived ingredients that are beneficial come in the form of potent plant-based antioxidants, while chemical ingredients that are beneficial include salicylic acid, benzoyl peroxide, retinol, and retinoids. While these are synthetic structures, they have also been proven in our studies to have specific benefits for the skin.”
Botanical ingredients are anti-inflammatory
Dr. Teo highlighted a few specific botanical ingredients that can address inflammation. “Centella Asiatica (CICA), also known as the Indian pennywort, has been well-established to be a potent antioxidant. Centella Asiatica reduces inflammation and promotes good healing of scars. Ingredients like those derived from avocado oil are rich in polyphenols and fatty acids. Oleic acid – can also help in inflammation as well as the healing of acne scars. Salicylic acid which was first derived from the bark of willow trees, is a chemical compound that can have good effects in terms of reducing oiliness of skin.”
What is the ideal cleanser?
On the topic of cleansers, Dr. Teo pointed out that the ideal cleanser is one that can effectively remove the oil, dirt, and grime, while at the same time, functions as a humectant. This means that it preserves a layer of moisture on the surface of your skin to minimize water loss to the environment — a phenomenon known as transepidermal water loss. “In individuals who have skin conditions such as acne, eczema, there is an imbalance in this bacterial count, and cleansing then particularly becomes an important part of the skincare routine. If the cleanser is too harsh on the skin, you’re going to aggravate these conditions because it dries the skin barrier out.
On the other hand, it has to effectively remove all these particles that are a breeding ground for bacteria.” She further elaborates, “If you find that your cleanser is making you feel that your skin is squeaky clean and a little bit tight after rinsing it off, this is a sign that it is far too drying and it may not even address your concern of having greasy skin. Such a phenomenon will actually lead to excess oil production as a compensatory response.”
Sulfate-based vs amino acid surfactants
“The science behind a cleanser is really that of surfactants, which are basically the key ingredients involved in the cleansing work.” In traditional sulfate-based cleansing surfactant systems, there is a very high pH environment. Over time, it increases the abrasiveness and dehydration of the skin’s barrier. All of which increase the skin’s susceptibility to infections and dryness.
How to use an acne spot cream?
If you are wondering what skincare routine one should adopt for acne-prone skin, Dr. Teo underlined the steps to take. “First, cleanse with a good cleanser that doesn’t dehydrate the skin. Now, the second part, moisturizing. If you suffer from acne or maskne, it’s good to have on hand an acne spot cream that works for you. If you tend to be acne-prone over the entire chin or the cheek area, on regular days, I would apply a thin layer of the acne cream over the entire acne-prone part of your face.
And when you have a pimple, depending on the recommended dosage of the product, to apply it at the earliest sign of the pimple developing. Finally, use sunscreen. Whenever you heal from a pimple, post-inflammation hyperpigmentation (PIH) is a concern, and wearing sunscreen can help to inhibit excess melanin production caused by inflammation, reducing scarring.”
Should people with acne-prone or oily skin type skip moisturizers? What type of moisturizers to use for oily skin?
On the importance of moisturizing, Dr. Teo brought attention to how skipping moisturizers even if you have oily skin is a myth. “The reason is that even when your skin is greasy, it may lack the lipid barrier that protects your skin from the environment. This is a common phenomenon in individuals who find that they have both oily and dehydrated skin.
If you have oily skin and you decide to skip a moisturizer and use a very harsh, astringent cleanser and toner, you may actually have you have a paradoxical phenomenon called reactive seborrhea. That’s when overproduction of oil occurs because the oil glands attempt to compensate. This is definitely not ideal when you are trying to control oily skin.” If you tend to have oily skin, avoid heavy cream formulas and opt for serums and emulsions in the daytime, especially in a humid climate like Singapore.
A dermatologist’s approach to treating acne or maskne – separating myths from facts
Preventing acne from reappearing on the same spot
“If you have acne that keeps appearing over a certain spot, you could actually have something a little deeper known as an acne cyst.” An acne cyst is essentially a collection of pus, dead skin material that is segregated by a cyst wall. While it may reduce when it’s less inflamed, the cyst wall persists.
If you’re having a recurrent, painful, deep acne bump that lasts for anything longer than 2 weeks, then the suspicion of having an acne cyst is more likely. On another note, Dr. Teo elaborates, “if you tend to get acne over a certain area such as your chin or your cheeks, then using the right products can help prevent the formation of microcomedones, to prevent appearance of acne.”
Letting our acne “breathe”
“This is quite a paradox because, on one hand, we know that occlusion acne can occur with comedogenic substances and more recently, maskne, which is acne mechanica due to occlusion of the face mask on skin. On the other hand, a moist environment is optimal for the healing of inflammation.”
“If you do not have inflamed acne, then it is important for your skin to have some breathability in terms of moisture-wicking because this breeds bacteria and can cause flare-ups in acne. However, if you do have inflamed acne, then using the right acne care product can help the acne to heal faster. The effects of such products can be enhanced by creating a moist, wound-healing environment such as using a hydrocolloid acne patch.
Should we pop our acne?
“Popping a pimple is always a bad idea because it can get more inflamed and you may introduce more bacteria. If you notice your acne is coming to a head and there’s pus at the surface, after a warm shower, you can use a damp cotton pad to gently compress the area and the pus should come out naturally. However, if you’re not able to do so, definitely don’t proceed to squeeze it.”
Best fabric to prevent maskne?
On the point of choosing the best fabric to prevent maskne, Dr. Teo suggested opting for functional textiles. “None of the natural materials are waterproof. However, if you’re talking about skincare, typically natural fibers tend to allow more breathability in layman’s terms.
What I am recommending my patients right now is the concept of functional textiles. So the usage of synthetic fibers, in this case, would be ideal because it’s waterproof, but it has to be treated so that it’s skin-friendly. There are several physical factors that can alter the breathability of synthetic textiles, such as incorporating certain metallic ions like silver, copper, and zinc which can confer antibacterial properties that can reduce the occurrence of maskne.”