Post-acne is pigment spots, scars and cicatrices that remain on the skin after acne has healed. With extensive skin lesions, cosmetic defects remain for a long time, and some of them can only be removed using hardware methods. A mask for acne spots is an equally effective way to combat post-acne. Such products have wound healing, lightening and anti-inflammatory properties. It is recommended to use therapeutic masks during the period of exacerbation of acne and immediately after the disappearance of inflammatory elements.
What you need to know:
- Not all facial dermatoses associated with wearing personal protective equipment are so-called “maskne”.
- The most common cause of rashes is irritant contact dermatitis.
- Maintaining the skin barrier and taking regular breaks from wearing masks are important aspects of treatment in addition to standard medical protocol for monitoring skin conditions.
The COVID-19 pandemic has led to a dramatic increase in the use of personal protective equipment (PPE) both in and outside of healthcare settings.
The term "maskne" has become increasingly popular during the pandemic, especially in the media, where it is used to describe certain types of facial dermatoses. People often purchase expensive but potentially ineffective medications to treat these conditions. In this article, the authors outline the most common causes of facial rash associated with wearing PPE and highlight key points to consider when assessing individuals with new or progressive facial dermatoses that they attribute to the use of facial PPE. In this article, “face PPE” refers to full face masks, visors, eye protection, surgical masks (surgical mask, FRSM type IIR), and respirators (e.g., FFP3, FFP2, and N95). Facial dermatoses associated with PPE are well described, but data on their prevalence are limited and descriptive terminology is often used instead of specific diagnoses. Based on the limited evidence available, mask-induced acne and irritant contact dermatitis are the most common dermatoses associated with mask wearing. During the COVID-19 pandemic, a prospective cross-sectional study of 833 healthcare workers in Thailand, including medical and non-medical workers, found that 54% reported adverse skin reactions to surgical and cloth masks.
As a rule, the patient develops a rash on the face or an exacerbation of an existing dermatosis, most pronounced in the area of the face covered by the mask. Ideally, such an examination should be carried out in person, but a video consultation is an acceptable alternative during a pandemic.
Key information to clarify regarding maskne:
- Local status, medical history, including family history of skin diseases, and a comprehensive medication history, including prescription, over-the-counter, and complementary medications.
- Temporal association with mask wearing: determine whether periods without wearing a mask provide relief and improve skin conditions, for example, allergic contact dermatitis should regress after a period without wearing a mask, whereas pimples (common acne), once present, may not react so quickly to the lack of a mask.
- Symptoms of itching, soreness and the appearance of pustules or papules.
- Duration of daily use of PPE.
- Ask if “mask rest” (periods of time when PPE is completely removed from the face) is allowed.
- Assess the impact on the patient's mood, work, and social life to determine severity and decide on further treatment. The impact of PPE-related dermatoses on the quality of life of healthcare workers can be significant.
The examination should focus on the morphology of the rash, the distribution and the presence of morphological elements of the rash on any areas other than the face.
Each condition described below may occur de novo or be aggravated by wearing facial PPE. An exacerbation usually occurs due to the formation of a warm, moist, occlusive environment around the face, facilitated by the use of a mask. Added to this is the friction effect of the material being held in place by the rubber band. General measures to prevent facial dermatoses associated with PPE are outlined below and are recommended for the treatment of all conditions listed below. Additional standard treatments for each dermatosis are discussed separately. When post-inflammatory hyperpigmentation or scarring occurs, a more aggressive treatment approach is required to prevent permanent skin changes. At this stage, if there is no improvement, a referral to a specialist is necessary.
Preventing the appearance of post-acne
The main task in caring for problematic acne-prone skin is not to aggravate its condition and not to provoke new rashes and the formation of a permanent spot or scar on the face.
Below are recommendations from experts that will help minimize the occurrence of imperfections and damage from them.
- Competently and promptly treat acne of degrees II and III;
- Do not expose stains to physical, chemical or mechanical stress;
- Avoid excessive sun exposure;
- It is good to moisturize problem skin;
- Wash regularly using sebum-regulating anti-inflammatory agents;
- Do not use alcohol-containing cosmetics in your arsenal (it can aggravate the skin condition);
- Use mattifying cosmetics to control oily skin.
Irritant contact dermatitis
Irritant contact dermatitis (ICD) is the most common occupational dermatosis associated with mask wearing. ECD is a form of exogenous eczema caused by direct physical or chemical damage to the skin. Manifestations of RCD associated with pressure while wearing face masks are usually found over the cheeks and bridge of the nose. In this case, dermatitis is associated with prolonged mask wearing (> 6 hours), and its severity depends on the irritant and duration of exposure. Manifestations range from discrete, dry, scaly patches to swelling and vesicles, erosions, and ulcerations. People with atopic dermatitis who already have a skin barrier defect are particularly at risk of developing RCD. Restoring the skin barrier is key to treating RCD, and taking regular mask breaks (every hour for respirators) is one way to achieve this. For broken skin, a silicone-based dressing (a thin, all-purpose sponge dressing for wounds with little exudate) can be applied to protect the skin while maintaining the mask's seal.
How to prepare your skin
Masks for acne spots should be applied to skin that has been previously cleansed of impurities. Due to this, the absorption of vitamins and microelements from cosmetics is accelerated. In preparation for the upcoming procedure, you must:
- wash with antibacterial soap;
- treat the T-zone with a scrub;
- apply a towel soaked in hot water to your face;
- wipe the skin with lotion.
Enlargement of skin pores and removal of natural oil increases the effectiveness of masks against age spots that occur after acne heals.
Allergic contact dermatitis
Allergic contact dermatitis (ACD) (Figure 1) is a delayed type IV hypersensitivity reaction to an external allergen that is much less common than ACD. This usually occurs after exposure to fixative chemicals such as formaldehyde and dibromodicyanobutane, but thiuram, a rubber accelerator found in the elastic straps of surgical masks, is also a recognized allergen. It has been reported that ACD on the face may be caused by nickel and cobalt forming a metal wire that is used to ensure that the mask fits more tightly to the face.
Figure 1. Allergic contact dermatitis
RCD and ACD may be clinically indistinguishable. Both usually present as localized dermatitis, but well-defined areas of inflammation and redness are more suggestive of ACD, while a more diffuse pattern is more often seen in RCD. Treatment is a short course of mild to moderate potency corticosteroids, such as 1% hydrocortisone ointment. Avoiding allergens prevents further episodes, and therefore identification of the causative agents is key. It can be carried out using a patch test, recommended for use in those cases and on those areas of the skin where well-demarcated areas are visible clinically, as well as in cases of severe disease.
Methods of treating post-acne in a cosmetology clinic
To get rid of the problem, our clinic uses different methods and their combination.
Chemical peeling
It is carried out with fruit, azelaic and salicylic acids. The action of peeling is aimed at reducing hyperkeratosis (excessive growth of the stratum corneum of the skin). The higher the acid concentration in the peeling solution, the more noticeable and sensitive the exfoliation will be.
As a result of the procedure, the boundaries between healthy skin and scars are smoothed, and the process of restoration (regeneration) of the tissues at the bottom of the atrophic scar is activated.
Mesotherapy
mesotherapy procedure is the subcutaneous administration of compositions of several medicinal substances or single drugs. The components are phospholipids, magnesium and silicon salts, polylactic acid, which improve the quality of the skin and activate regeneration and repair processes.
Also used: enzymes, vitamins, antibiotics, antioxidants, biorevitalizers, corticosteroids, immunomodulators and other biologically active substances.
Plasmolifting
Plasmolifting is the introduction of platelet plasma obtained from the patient’s own blood into the deep layers of the dermis. The complex treatment method helps to effectively deal with scars caused by acne.
First, the doctor carries out controlled damage to the upper and middle layers of the skin, using laser or chemical peeling and grinding. This accelerates the synthesis of new skin cells. In this way, scar tissue is replaced with healthy tissue.
The second stage is plasma lifting itself, which activates regeneration and accelerates skin restoration.
Laser therapy
A highly effective method of getting rid of post-acne, the manifestations of which cannot be eliminated by other means. In the clinic, treatment is carried out with 2 types of laser: Picosure (fractional non-ablative effect) and carbon dioxide Eraser-C RF (laser ablative resurfacing).
The most widespread is laser resurfacing using a CO2 laser. With this therapy, sufficient (from 50% to 80%) clinical improvement in the scar area is recorded after just one procedure. Efficiency increases due to the activation of collagen synthesis. When radiation is absorbed by the skin, they heat up, after loss of fluid, the cells are destroyed, tissue coagulation occurs, the destruction of old elastin and protein is gradually replaced by new structural elements. The duration of the procedure is determined by the type of laser and the amount of intervention required. It can range from 15 to 90 minutes.
Seborrheic eczema
This type of dermatosis (Figure 2) affects approximately 1–3% of adults in the population and usually manifests at a young age. On examination, dermatitis with greasy yellow scales is often observed, affecting mainly the scalp, eyebrows, glabellar and nasolabial folds. Treatment includes regular use of antifungal medications, such as ketoconazole 2% shampoo, and/or short courses of topical corticosteroids, such as hydrocortisone 1% ointment. As with atopic eczema, the warm, moist occlusive environment created by wearing a mask may predispose to the development of seborrheic dermatitis.
Figure 2. Seborrheic eczema
Perioral dermatitis
Perioral dermatitis is a macular erythema with very small papulopustules affecting the periocular and perioral skin of young women (with preservation of the red border of the lips). It can be either idiopathic or caused by the use of cosmetics or topical corticosteroids directly or indirectly (via fingers applying the product to another area of the skin). Wearing a mask may predispose to the development of perioral dermatitis for reasons similar to those listed for atopic and seborrheic dermatitis. Treatment includes stopping the use of creams and simplifying skin care. In milder cases, topical antibiotics such as erythromycin are sufficient, but a four-week course of tetracycline—for example, 408 mg of lymecycline once daily—is often required.
How to get rid of post-acne on your face at home?
Stagnant spots left by acne are most often removed in a beauty salon, but with the help of pharmacy cosmetics with active formulas aimed at intensive restoration and renewal of the epidermis, it is possible to significantly improve the condition of ex-problem skin at home.
How to remove post-acne using skincare products:
- Sebum-regulating products (washing gels, tonics and lotions) will help solve the problem of enlarged pores, keep them clean and prevent the occurrence of inflammatory processes and new rashes.
- Whitening creams and serums for daily care will help get rid of pigmentation.
- Homemade acid-based peels are effective for any manifestations of post-acne, even out skin tone and texture, and promote accelerated cell regeneration.
- Masks based on natural clay also help narrow pores, control sebum synthesis and prevent the emergence of new imperfections.
To lighten pigmentation, pay attention to creams and serums with components whose action is aimed at suppressing melanin synthesis: kojic acid, arbutin, glabridin, ascorbic acid, azelaic acid.
Alexander Prokofiev, medical expert of the La Roche-Posay brand
Hives
Both compression and contact urticaria (Figure 3) are rare complications of PPE use. Compression urticaria occurs due to downward pressure from the mask and is characterized by the formation of blisters immediately or with a delay (4–6 hours) after the onset of compression. Wearing a well-fitting mask that is not too tight is recommended, or alternatively changing PPE frequently. Contact urticaria is an immediate reaction to an offending allergen such as latex or formaldehyde. It usually goes away within 24 hours after the trigger is removed. Regular use of antihistamines such as loratadine is the mainstay of treatment for inducible urticaria.
Figure 3. Urticaria
Acne (acne)
Acne vulgaris (Fig. 4) is a chronic inflammatory disease of the skin and hair. PPE-associated acne, which can be considered a subtype of mechanical acne, occurs both in people with a history of acne and in those who have not previously suffered from acne. This type of rash is associated with wearing surgical masks and N95 respirators. The pathogenesis of PPE-associated acne is thought to have three key aspects:
- Creating a humid microclimate inside the mask.
- The mucous membrane can become colonized with bacteria, which increases the bacterial load on the surrounding skin.
- The frictional effect of a tight-fitting mask can damage the opening of the follicles, causing irritation, the detrimental effect of which is aggravated by high temperature and humidity.
Retinoids, such as adapalene gel cream, alone or in combination with benzoyl peroxide cream once daily, may be used in mild cases. For moderate to severe rashes, an oral tetracycline such as lymecycline 408 mg once daily for 12 weeks can be added to the treatment regimen.
Figure 4. Acne
How to prevent pigmentation and acne marks
Acne is a consequence of disturbances in the functioning of internal organs and dermatological pathologies. To prevent their occurrence, you should:
- normalize diet;
- comply with sanitary and hygienic rules;
- Wash your face with a scrub (gel, soap) once a week;
- to refuse from bad habits;
- take multivitamins;
- drink up to 2 liters of mineral water per day.
If pimples appear, you should not squeeze them out, as this can cause injury to the skin and the formation of age spots. To prevent negative consequences, acne is treated only with medication or hardware in the office of a dermatologist or cosmetologist.
Rosacea
Rosacea (Figure 5) typically affects adults aged 30–50 years with fair skin. Typically, patients experience facial erythema and telangiectasia on the convex parts of the face (chin, cheeks, nose, forehead). The classic zone of rosacea distribution coincides with the area in contact with the mask when it is worn correctly. The chronic course and presence of telangiectasia usually helps to distinguish rosacea from perioral dermatitis. Rosacea can be caused or worsened by wearing a mask for long periods of time. Drug treatment includes topical agents such as 1% ivermectin cream once daily for mild cases. An oral tetracycline, such as moderate-release doxycycline 40 mg once daily for 8 to 12 weeks, can be added to the regimen for moderate to severe cases of the disease.
Figure 5. Rosacea
Folliculitis
Folliculitis (Figure 6) on the face is more common in men and is associated with facial hair. Occlusive folliculitis, bacterial folliculitis, and pseudofolliculitis barbae (caused by ingrown hairs and poor shaving of the face and neck) have clinically similar presentations with papules, pustules, and, less commonly, nodules. A smear can rule out a bacterial infection. Gentle daily cleansing with a soap-free cleanser, gentle exfoliation (to remove ingrown hairs), and replacing dry shaving with wet shaving using special products can all help combat the condition. Antibiotic treatment is indicated where the presence of bacteria is detected; in purely inflammatory (sterile) cases, a combination steroid/antimicrobial cream can be used.
Figure 6. Folliculitis
- Cleanse your skin with a mild, soap-free cleanser.
- Apply a light emollient at least 30 minutes before putting on facial protection.
- Use special protective dermatological patches, sticking them on the skin of the bridge of the nose and cheeks.
- Wipe the skin under the PPE with a silicone-based protective cloth to form a film that protects the skin from the harmful microenvironment.
- Take the time to adjust the mask to your face and make sure it is not too tight.
- Take regular breaks from using the mask (every hour for respirators) to relieve pressure and prevent moisture buildup.
- Drink enough water.
- Maintain good oral hygiene (brushing teeth twice daily and flossing/brushing daily).
Consider seeing a dermatologist if the condition is severe or if the condition does not respond to the treatments described above. Also consult a specialist if special tests are indicated for you, such as skin testing and patch testing if you suspect a contact allergy.
- Consider how facial dermatosis affects the patient's quality of life, work, and relationships with others.
- Consider the different Fitzpatrick skin types when making treatment decisions, given the higher risk of post-inflammatory dyspigmentation and/or scarring in darker skin types.
- Consider the professional implications of diagnosis and treatment for the patient and discuss these as part of the consultation.
Honey mask
How to remove red marks from acne using honey, what ingredients are needed? First of all, take liquid honey and then add the same amount of cinnamon powder to it.
It is enough to use two tablespoons of ingredients. Mix the mask well and distribute it over problem areas with a brush. Wait 20-30 minutes and rinse with warm water.
Please note that honey is a potent allergen. To avoid harm to your health, consult your doctor before using it.
Photo: pixabay.com: UGC
