Wearing a Mask

Wearing a mask is important Photo

Wearing a Mask is an important part of the fight against COVID-19

We are all living in particularly uncertain times. The coronavirus pandemic has naturally made most of us anxious about our health, including the health of our skin as we adopt safety measures such as wearing a mask. 

The use of Personal Protective Equipment (PPE), notably face masks, has become an important weapon in our arsenal in the fight against the SARS-CoV-2 virus and COVID-19. Research shows that face masks, even of the reusable cotton type, can help to substantially reduce the risk of infection.1 Wearing a mask reduces transmission of the virus by limiting the distance that airborne droplets travel, such as those expelled when sneezing or coughing, by about 50% compared to the distance these droplets would travel if the person wasn’t wearing a mask.2 Not only that, wearing a face mask also provides greater protection to the wearer by blocking the droplets expelled by another person.2 This actually makes social distancing more effective,3 as the recommended 1-2m distance is far enough away that the vast majority of droplets, which are only transmitted about 35cm when wearing a mask,2 do not reach the next person. While the science is strong, and the need to wear face masks is critically important in helping to curb the spread of the virus, this doesn’t mean that there are no downsides to wearing one, especially for our skin.

How facial skin can be affected by face masks

The skin is a complex organ that requires carefully balanced environments, both inside the body and out, to function effectively. As the skin is literally the body’s first line of defence to the outside world, this means that it is particularly sensitive to changes in factors such as temperature, humidity and friction. If any of these are too high or too low, your skin can react in a multitude of ways, from dryness to redness to irritation.4

Wearing a mask for extended periods of time is introducing a relatively enclosed environment that can increase temperature on that part of the face. Increasing temperature can also increase sebum (oil) secretion, potentially giving rise to skin breakouts and pimples or, in some instances, acne. This mask-induced acne has even given rise to a new term: ‘maskne’.5

In addition, exhaled breath can lead to some condensation within the mask itself, increasing the moisture content on the skin. This can irritate the skin, and is fertile ground for acnecausing bacteria. Finally, the mechanical friction caused by wearing a mask, especially behind the ears and around the cheeks, nose and chin, can lead to irritation and redness.

An internet survey from this year found that, of a total of 2,307 replies from the general public in Poland, 1,393 people, or just over 60% of respondents, reported wearing a face mask during the previous week.6 Of these people, 273 (19.6%) reported experiencing itch, 2 and it was found that people with sensitive skin or common skin conditions such as acne or eczema had a significantly greater chance of experiencing itch.6 The authors additionally found that almost 30% of people experiencing itch either tried to scratch over the mask or removed it to scratch, reducing the protection afforded by correct mask usage. 6

Clearly, the effects of a face mask on the skin can be uncomfortable and potentially lead to incorrect usage. Below are four considerations to keep in mind to help make wearing a mask as comfortable as possible.

How to manage the effects of mask-wearing on your skin

Step 1: Hydration is key to the proper functioning of the skin.

The use of moisturisers can help alleviate dry skin and itch. The European Guidelines for Chronic Pruritus (itch), for example, lists moisturisers as one of the basic options to help alleviate itch.6

The outermost layer of the skin, the stratum corneum, consists of layers of flattened, dead skin cells embedded in a lipid bilayer, and it is through this layer that moisture can be lost to the outside environment. As the skin loses moisture, the integrity of the stratum corneum becomes impaired, leading to small cracks and gaps forming in between the cells. This not only leads to dry, flaky skin, it allows the passage of irritants and allergens into the skin, causing irritation and even flare-ups of existing conditions such as eczema.

One way to combat this is through the use of well-formulated, effective moisturisers. By using products that contain ingredients such as occludents, emollients and humectants that mimic how the skin naturally hydrates itself, you can not only offset the dryness that can be caused by face masks, but also help to reduce irritation and discomfort. In addition, moisturisers containing occlusive ingredients such as petrolatum or silicones such as dimethicone can help to form a water-resistant barrier on the skin, reducing the negative impact of too much moisture building up under your mask.

The QV Range contains products that have been scientifically formulated to provide varying levels of moisturisation for all skin types. QV Cream and QV Skin Lotion are highly concentrated, light formulations specifically designed for sensitive skin and protect against water loss by sealing in the skin’s own natural moisture.

If dryness and irritation persist, you may want to try moisturisers with a heavier, occlusive base. These can feel greasier than lotions or creams, but they will form a layer on your skin, trapping moisture in. By using these types of moisturiser at night while you sleep, you do not need to worry about discomfort or the effects of wearing a mask. QV Intensive Ointment, which is designed for extremely dry skin, is a water-free formulation that won’t sting if applied to skin that is particularly dry or even cracked.

Step 2: Choose the correct products to help manage break-outs

If the build-up of sebum on the skin as a result of mask wearing is leading to pimples or mask-related acne, you may want to try topical products that are designed to unclog pores of dirt, sebum and bacteria. Active ingredients such as azelaic acid have been shown to be effective in combating the key factors of acne, including inflammation, the build-up of bacteria, and the formation of blackheads.7 Other topical skincare ingredients such as niacinamide, or Vitamin B3, have also demonstrated effectiveness against acne.8 3 If you are unsure what products may help, or if your acne is severe, talk to a GP or dermatologist.

Step 3: Practice good hygiene and use a cleanser that won’t aggravate your skin

In addition to masks, another key recommendation by healthcare bodies during this pandemic is frequent and thorough hand hygiene. Washing your skin with water and soap (or a non-soap based cleanser) is one of the best things you can do to help stop the spread of the novel coronavirus.9 But cleansing the skin properly is also important when it comes to managing the impact of prolonged mask wearing. As noted above, the increased temperature of your face when under a mask can lead to the build-up of sebum and the clogging of pores, so a daily routine that utilises a cleanser and water can help to offset this. Soap is the traditional cleanser of choice for most people, but as it is naturally alkaline, and our skin is naturally slightly acidic, soap can alter the skins composition10 and lead to irritation, especially for people with sensitive skin or pre-existing skin conditions. Using a gentle, pH balanced cleanser in place of soap will cleanse the skin just as well as soap without aggravating it. In the QV Range, QV Gentle Wash is a soap-free, lightly foaming gentle cleanser designed with sensitive skin in mind.

Step 4: Wear the correct mask

The quality of the fit or design of face masks may be significant factors in determining how you skin reacts. Ill-fitting or badly designed masks will not only be ineffective but may significantly increase dry skin or irritation. For instance, a loose-fitting mask may constantly move about your face, leading to friction around the ears, nose and chin, whereas a tight mask may cause deep indentations on your skin, increasing the likelihood of irritation and dryness.

When choosing a mask, pay particular attention to the fit and the material used. For the general public, respirators and filtered masks may not be necessary. In this case, washable cotton masks are best as the material is more breathable than synthetic fabrics such as polyester. Remember to wash the mask in hot water between every use, which will be at the end of the day for most.

Spending a little time to ensure that your face mask is suitable and comfortable, and ensuring that you have appropriate and efficacious topical products to help your skin, is the best course of action to make the wearing of face masks as comfortable as possible.

Face masks + social distancing + proper hygiene= a flattened curve

It is more important than ever to remain vigilant and practice each and every guideline to help combat the spread of COVID-19. In addition to face masks and other protective equipment, maintaining social distancing and practicing effective hygiene, such as washing your hands often for at least 20 seconds with soap or a non-soap based cleanser, remain our most effective weapons to date in this fight.

  1.  Chu DK, Akl AA, Duda S, Solo K, Yaacoub S, Schunemann HJ. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. Lancet 2020;395(10242):1973-1987 
  2. Dbouk T, Drikakis D. On respiratory droplets and face masks. Phys Fluids 2020;32(6):063303
  3. Ngonghala CN, Iboi E, Eikenberry S, Scotch M, MacIntyre CR, Bonds MH et al. Mathematical assessment of the impact of non-pharmaceutical interventions on curtailing the 2019 novel Coronavirus. Math Biosci 2020;325:108364 4 
  4. Engebretsen KA, Johansen JD, Kezic S, Linneberg A, Thyssen JP. The effect of environmental humidity and temperature on skin barrier function and dermatitis. JEADV;30(2):223-249 
  5. Tan Y. BBC. ‘Maskne’ and bold makeup: how masks are changing how we look. [internet] 2020. Available from: https://www.bbc.com/news/world-53468051 
  6. Szepietowski JC, Matusiak L, Szepietowska M, Krajewski PK, Bialynicki-Birula R. Face maskinduced itch: a self-questionnaire study or 2,315 responders during the COVID-19 pandemic. Acta Derm Venereol 2020;100:adv00152 
  7. Sieber MA, Hegel JKE. Azelaic acid: properties and mode of action. Skin Pharmacol Physiol 2014;27(suppl 1):9-17 
  8. Khodaeiani E, Fouladi RF, Amirnia M, Saeidi M, Karimi ER. Topical 4% nicotinamide vs. 1% clindamycin in moderate inflammatory acne vulgaris. Int J Dermatol 2013;52(8):999-1004 
  9. WebMD. The Power of Hand-Washing to Prevent Coronavirus. 2020 [internet]. 06/03/2020. Retrieved 31/07/2020. Available from: https://www.webmd.com/lung/news/20200306/power-of-handwashing-to-prevent-coronavirus 
  10. Lambers H, Piessens S, Bloem A, Pronk H, Finkel P. Natural skin surface pH is on average below 5, which is beneficial for its resident flora. Int J Cosmet Sci 2006;28(5):359-70