Ask the Pharmacist

Q.) Due to my job, I have been wearing a face mask for long periods and now my face is suffering from acne and dermatitis. What can you suggest?

A.) Not only are more people than ever wearing masks but many are wearing them for extended periods of time. Most of the masks that are available (or not available due to this pandemic) on the market, were not intended to be worn for long periods. The official recommendation was to wear a mask for no more than four hours and to be changed between patients if you are a health care practitioner.

Now, due to the lack of personal protective equipment (PPE), many have no choice but to wear the same mask for much longer than suggested. Wearing your own “used” mask is better than not wearing any mask if there isn’t any new PPE to be had. But there are drawbacks to this. Unfortunately, our skin may suffer the consequences of this new face mask routine.

There are several reasons that some people are dealing with these skin challenges. First off, some people are wearing their mask too tight. This causes a pressure point where the mask has contact with the head and therefore leads to friction with the skin. Though a tight mask may make you feel safer with this coronavirus, our skin may not like the increased pressure that the mask exerts on the face. Our skin is thinner in some areas like the bridge of our nose (as well as behind our ears and under our chin) making it more susceptible to injury. This pressure may not be extreme but over the course of a day(s), the skin can show signs of pressure and if not dealt with appropriately may lead to ulceration and possibly over time an infection. In a perfect scenario, the mask would be removed after 4 hours to relieve the pressure points on the skin. More often than not, this is not feasible due to the increased workloads our front-line staff are bearing as they work long shifts due to this unique situation.

Secondly, donning a face mask for an entire shift (either a new mask daily or in some cases the same mask re-worn every day) can trap moisture and heat under the mask and lead to heat rash reactions, acne and a worsening of rosacea. As well, fungi thrive under such conditions so it is not surprising to learn that our skin may have yeast issues as well under our mask.

Knowing we are unable to change our masks often enough and/or wear them for shorter periods of time, here are a few suggestions to help minimize the damage to our skin:

  • Ensure your mask is tight enough to be effective but not too tight as to cause pressure points or sores. Some people have creatively reduced the pressure the mask has on the ears with headbands, elastic loops, buttons etc. Just ensure the mask is still covering your mouth and nose and, in the case of an N95 mask, that it still has a good seal.
  • Wash the face twice daily with mild soap (ideally unscented) and water. If you are acne prone, you may choose to use a commercial salicylic acid preparation to wash your face with such as Neutrogena’s oil free acne wash.
  • Use a hypo-allergenic facial moisturizer and ensure it is non-comedogenic (i.e. does not clog pores). You may even add a second layer of moisturizer to protect your skin further. It is suggested to moisturize the face at lease 1 to 2 hours before putting on your mask; otherwise the moisturizer may cause greater friction and further worsen the problem.
  • You may wish to try a skin barrier wipe (such as 3M’s Cavilon No Sting Barrier Film Wipes) just prior to putting on your mask to help reduce the “wear and tear” the mask can have on the contact points.
  • Avoid wearing make-up under the mask or use the bare minimum since make-up can also make the skin more congested and lead to problematic areas.
  • Hydrate! Hydrate! Hydrate! Make sure you drink plenty of water to keep the skin well hydrated from within.

Since there isn’t enough PPE for people to change their mask regularly, many people have looked to make their own masks at home. There are many DIY home-made masks to be found on the internet.

If you do choose to make your own, opt for a material that is 100% cotton. Material that uses synthetic fibres may result in more heat retention and thus more skin irritation. You can double up a cotton pillowcase with a 600 thread count or use flannel PJ’s that provide up to 60% filtration. Test the fabric by holding it up to the light. If light goes through easily then the fabric may not be as safe as another fabric that filters out the light more. Bear in mind however, that a fabric that is too thick and filters out nearly all of the light will make it difficult to breathe under. One benefit of using a homemade cloth mask is that it can be washed and re-worn.

If your job requires you to wear an N95 mask, then the homemade mask will not be of use to you. If you are expected to wear a surgical mask, which is not washable, then perhaps you should consider the homemade cotton mask.

This is a good time to review how to wear a mask effectively and efficiently. Before donning your mask, wash your hands with soap and water or use an alcohol-based hand sanitizer. Secure the mask behind your ears (or tie it behind your head if it has strings), covering both your face and nose and ensure you do not have any gaps between the mask and your skin. It is not useful to wear a mask that does not cover both your nose and your mouth.

One purpose of the mask is to prevent the droplets from our mouth (breathing, talking, coughing) and nose (sneezing) from adhering to any surrounding surface. Therefore, do not move the mask away from your face to speak to somebody. Lastly, avoid touching the front of your mask while you wear it. If you catch yourself doing so, wash your hands or use a hand sanitizer as soon as you can afterwards.

For more information on this or any other topic, contact your pharmacist.