NEW YORK— There have been many casualties from the pandemic this past year, and as a practicing dermatologist, I certainly didn’t expect the indirect casualty on our skin’s health.

Mask wearing is absolutely essential to protecting ourselves and others from the COVID-19 virus, and part of an effective mask is good, tight adherence to our skin, which unfortunately doesn’t bode well for many skin conditions. Skin requires communication with the surrounding environment to behave optimally, receiving signals about humidity, environmental stressors, temperature, among others signals, and an effective mask interferes with its ability to process these signals accurately.

Masks also induce an environment of bacteria-laden air, as we re-breathe on our faces underneath. Dermatologists have witnessed a surge in inflammatory skin conditions of the face due to the new mask-wearing normal, predominately among those with sensitive skin, but other skin types as well. The challenge for most patients is to understand what condition they’re experiencing — eczema, rosacea, acne or something else — and how to minimize flares.

Sensitive skin is a general skin type that has shown intolerance to many ingredients, fragrances and additives in skin care products, and those with sensitive skin often experience symptomatic discomfort of their skin (including stinging, redness, itching and burning) after exposure to varying temperatures, dietary triggers and more abrasive skin treatments. Although the term sensitive skin is a vague one, oftentimes it includes medically diagnosed conditions such as rosacea and eczema.

Dr. Rachel Nazarian

Rosacea, one condition that has flared greatly with the use of masks, can often mimic many other medical conditions, and has a number of subtypes that have their own presentation. A classic finding of rosacea is the symptomatic experience of burning and stinging that accompanies the bumps and blemishes. These symptoms are less common with acne, which, when severe, may present some tenderness of deeper lesions.

“Maskne” is a term that has been used to describe a certain skin condition often seen with mask use: It is meant to indicate a type of Acne mechanica, which is triggered by friction and rubbing caused by the tight-fitting masks being worn to protect us from COVID-19. These blemishes are often noted along the borders of the mask, either on the cheeks or around the lower face and jawline, where the pressure and friction are greatest. Many people find that these bumps and blemishes are inflamed and are triggered shortly after wearing a mask for a period of time.

Having both rosacea and acne is uncommon in younger ages, but is more often seen in adulthood, specifically the adult women demographic. The reasons are unknown, but rosacea is often a sensitivity of skin that develops in adulthood, and hormonal fluctuations may play a role, which is often also a trigger for adult-onset acne. Telling the difference can be quite challenging, and it generally requires an evaluation by a dermatologist.

The treatment can also be tricky, since many acne medications may actually disrupt the skin balance that can then flare rosacea. Having the assistance of a medical doctor trained in treating both concurrently is often the wisest step, and the quickest way to achieve healthy skin. Both may appear as red bumps, whiteheads, deep cyst, and may have long-term damage to skin if left untreated.

The following tips can be followed for those who struggle with sensitive skin:

• Keep water temperature tepid when washing your skin; avoid hot water or very cold water, which can inflame the skin and trigger flares.
• Choose gentle skin cleansers without abrasive exfoliative beads, added chemical exfoliants or those that require foaming for cleaning. Instead, look for mild cleansers that are non-foaming and remove dirt and bacteria without stripping natural hydrators from the skin.
• Look for skin care products that do not contain added perfumes and fragrances; these ingredients add nothing to the efficacy of the product, and are common irritants to those with sensitive skin.

For people who are struggling with maskne, some simple skin care changes can make a big difference:

• If you can, without compromising your health or risk level, switch to a softer fabric to minimize surface friction on your skin. The stiffer fabrics grip skin and leave more friction with movement, making maskne worse.
• Wash your mask often, at least daily. The combination of pressure and friction is worsened with skin surface bacteria that can aggravate skin and inflame the acne to a greater degree.
• Treatment is often necessary with many cases of maskne. The ability to go mask free is not an option for most of us, and since the mask is a cause of this skin condition, many people would benefit from a nightly acne regimen to combat the ongoing condition. Topical anti-acne treatments may be useful, but oral options are also available from your dermatologist.

For those who are struggling with rosacea, I would recommend simplifying your skin care regimen. Often, the ingredients in your skin care products may not be suitable for your skin type. Start with the basics only: a gentle cleanser and moisturizer. This will allow the skin to rebalance its pH and calm a rosacea flare.

Also, keep track of your dietary intake and possible triggers. If you’re experiencing a rosacea flare, keeping a food diary may be quite helpful in identifying dietary triggers which may be contributing; often alcohol, spicy foods, caffeine, or specific foods like tomatoes, may exacerbate your skin condition. The triggers can vary from person to person, so monitor intake surrounding a flare to determine if that’s playing a role in your rosacea.

And lastly, don’t wait to seek help. Dermatologists are physicians that have trained for many years to appropriately and effectively treat rosacea. Rather than delaying treatment, and risk worsening of skin disease and discomfort, scheduling an appointment with your dermatologist may save you years of skin struggle, and help you achieve healthier skin sooner.

Because rosacea is often flared directly as a result of mask wearing, it’s unlikely this particular trigger can be avoided until the pandemic has abated. Often, those suffering from rosacea require oral medications to manage their flares. As soon as you are aware and concerned about your skin, if you feel you’re compensating for the blemishes, or if the symptoms of inflamed skin are affecting your quality of life, you would absolutely benefit from medication. Remember, untreated rosacea may have long-term consequences to skin and may damage the delicate skin tissue if neglected.

Reach out to your dermatologist to ensure treatment for any of these skin conditions is not delayed. Many dermatologists offer telemedicine visits, allowing the patient to have an evaluation without traveling to the office. As with all skin disease, the earlier you seek accurate diagnosis and treatment, the greater your overall health and quality of life.

Rachel Nazarian is a practicing dermatologist with Schweiger Dermatology Group in New York, a faculty member at Mount Sinai Medical Center’s Department of Dermatology, and a frequent contributor in online and print media educating the public on skin disease and skin cancer prevention.