How to Deal With Irritation from Face Masks and Coverings

Facial coverings are encouraged across the country during the COVID-19 pandemic. For some people, this protective measure may result in a bit of skin irritation. This can be a real problem, particularly for healthcare and essential workers who must wear face masks all day.

One reason irritation occurs is that facial coverings do not allow airflow to the face; when a person breathes, moisture accumulates and becomes trapped on the face. That dark, warm environment can facilitate skin issues like acne. In addition, masks and facial coverings can irritate the skin simply by rubbing against it, or by exposing the skin to allergens.

If masks are causing you any of the below skin issues, know there are both treatments to help and preventive measures to stop it from recurring.

Dry, Itchy Skin

Wearing a facial covering for extended periods of time can cause skin to become itchy and to peel. If it's made out of fabric like cotton, the material can absorb natural oil on your face, leaving your skin dry. And residue from laundry detergent and fabric softeners can irritate skin as well (frequent washes of the mask are encouraged).

How to Treat It

• Use gentle, non-abrasive cleansers to wash your face, like Dove, Cetaphil, or CereVe.
• After cleansing, pat (don’t rub) your skin dry.
• Apply moisturizing cream to rehydrate your skin. Look for skin moisturizing products that contain ceramides, which help the skin maintain a healthy barrier to retain moisture. Ingredients like glycerin and hyaluronic acid are also helpful to draw moisture into the skin.

How to Prevent It

Using a good moisturizing product is vital to preventing dry, itchy, or peeling skin under a mask. Other prevention measures include:

• Avoid moisturizers that contain mostly water, which can be identified when water is listed as the first ingredient. These products may exacerbate dry skin.
• Avoid products with alcohol. They may burn and sting the skin, causing more dryness and peeling.
• Avoid products with retinoids, such as anti-aging products
• Avoid any type of peels or scrubs with hydroxy acids, which may irritate dry skin even more.

Dermatitis

A skin rash caused by wearing a facial covering for prolonged periods of time is likely irritant contact dermatitis, the most common form of dermatitis. This type of dermatitis is caused by direct contact with something that irritates the skin. Symptoms include:

• Red rash
• Itching, which may be severe
• Dry, cracked, scaly skin
• Bumps and blisters which may ooze and crust over
• Swelling, burning, or tenderness.

Dermatitis can also be caused by an allergic reaction to material in the mask, such as rubber, glue, metal, or formaldehyde. This form of dermatitis is called allergic contact dermatitis. Unlike irritant contact dermatitis, which can begin shortly after exposure to the mask or facial covering begins. an allergic dermatitis reaction may take up to 48 to 96 hours to appear.

How to Treat Contact Dermatitis

The American Academy of Dermatology lists some simple ways to treat a mild case of contact dermatitis:

• Take antihistamines, such as Benadryl.
• Use a topical steroid cream (such as 1% hydrocortisone) twice each day for one week, followed by once a day for another week or two.
• Use a gentle skin cleanser.
• Avoid harsh scrubs, retinoids, and hydroxy acid products.

How to Treat Allergic Dermatitis

Treatment for a skin rash caused by an allergy is aimed at eliminating the source of the allergy. In this instance, it’s important to use a different type of facial covering. If you are using a surgical face mask, consider a cloth one instead. If you are wearing a cloth mask, try a different type of fabric. Cotton is usually considered less allergenic than polyester. Additionally, wash the fabric using hypoallergenic, fragrance-free laundry detergent before wearing.

Once the skin rash begins to clear up, slowly taper off any hydrocortisone cream you may be using, but continue with heavy moisturizer to help prevent recurrence. 

Acne

Those who are prone to acne may have an increase in breakouts as a result of wearing a facial covering. Any microorganisms or bacteria on your skin become trapped within the mask. When paired with dampness from breathing and sweating, this can contribute to clogged pores and breakouts.

How to Treat It

Standard types of treatment for acne, such as benzoyl peroxide and retinoid treatment, can take time before effectiveness is visible. Some experts warn that these types of treatments under a mask may result in even more irritation. Instead, you should:

• Use a gentle, non-comedogenic cleanser (a skincare product formulated so that it does not clog pores) to wash your face twice each day.
• Limit the time you are wearing the mask whenever possible by staying home. If you are not normally prone to getting acne, your skin should clear up as you decrease the amount of time covering your face.

How to Prevent It

• Avoid moisturizers that can clog the skin. A good non-comedogenic moisturizer is CereVe moisturizing cream.
• Wash your face before going to bed and never sleep with makeup on.
• Avoid excessive sunlight exposure and wear sunscreen (SPF 30+) daily.  Sunlight can darken post-inflammatory pigment changes that are often caused by previous acne breakouts. 
• Avoid foods containing high amounts of sugar and foods high on the glycemic-index. Some studies have found high amounts of sugar in the diet to be linked with acne. 

Rosacea

Rosacea is a skin condition involving enlarged facial blood vessels, causing the nose, cheeks, forehead, and chin to have a flushed appearance. The condition can also affect the chest.  It has many triggers, including heat. Wearing a facial covering increases the temperature of the skin, potentially causing a rosacea flare.

How to Treat It

Just like the treatment of acne, there are some medications that can be prescribed for the treatment of rosacea, but most take time. Therefore, the aim of addressing rosacea when wearing a face mask or facial covering is to prevent flare-ups.

How to Prevent It

• Cool your face off whenever possible throughout the day by removing the mask whenever it isn't necessary. Splashing your face with cool water can also help.
• Use skincare products that are fragrance-free and avoid ingredients such as alcohol, camphor, and sodium laurel sulfate.
• Avoid the use of toners or astringents.
• Avoid caffeine and alcohol consumption
• Avoid spicy foods and other foods that are known to cause flare-ups, such as yogurt, chocolate, and soy sauce
• Avoiding activities that trigger excessive sweating with your mask on, if you can.

Sores Spots on the Ears or Nose

Wearing a face mask or facial covering for long periods of time can result in soreness over the ears and nose. This is caused by the friction of the mask rubbing on the skin. 

How to Treat It

Taking a break from wearing your facial covering whenever it is safe to do so is the best way to help sore spots heal. Consider changing the type of covering you are using; for example, try a bandana rather than a covering that hooks onto your ears (like a surgical mask).

How to Prevent It

Using a product called Duoderm dressing (available over the counter) on the areas where the sores appear can help reduce friction, preventing further skin breakdown. Duoderm is a soft, gel-like substance that is used to create a moist wound-healing environment on the skin. Other types of material can be used to prevent friction, such as Vaseline or zinc oxide.