Maskne: Why the mask causes inflammation and how to avoid irritation?

Why does irritation and inflammation occur?
A mask that is attached to the face causes friction and squeezing in areas of tight contact - usually the bridge of the nose and under the eyes. If you wear the mask for a long time, red streaks, abrasions, irritation and even small wounds and abrasions may appear on these areas of the skin. If the mask has to be worn every day, then the skin does not have time to recover from damage and irritation progresses, occupying an ever larger surface and causing discomfort. In fact, these irritations can be compared to calluses on the feet - areas of hardened skin appear as a result of the same pressure from uncomfortable shoes.
 
Another problem is inflammation
Any friction and irritation causes damage to the skin, which facilitates the penetration of bacteria and dirt into the skin. This causes inflammation ("maskne"). Typically, these pimples are localized in the chin, nose and cheeks. Sweat and moisture, which are especially active under the mask, accumulate on the skin and clog the pores. Even our own breathing can lead to the appearance of a mask: with each exhalation, the moisture under the mask increases, creating a greenhouse effect. Increased humidity affects the pH of the skin, and this can lead to more active growth of bacteria and the appearance of inflammation.
 
How to avoid maskne?
To prevent inflammation, you need to change your daily skin care routine and carefully choose the mask you wear every day. If it is a reusable protective dressing, then a mask made of silk or with a silk lining is better. Firstly, this material is suitable for people with sensitive skin and has antimicrobial properties. Secondly, silk is highly hygroscopic - that is, it absorbs moisture well (for example, sweat and condensation formed when breathing under a mask). A cotton mask is better than a neoprene mask as it is less irritating to the skin. But dense material absorbs moisture worse, can create a greenhouse effect and chafe the skin. The most common thin neoprene models can increase perspiration and cause mechanical irritation by adhering tightly to the skin.
However, any reusable mask must be carefully processed after each use - both to protect against the virus and to prevent inflammation (oil and dirt accumulated on tissue can cause mask). The reusable mask does not last forever and after a certain number of uses it will have to be replaced with a new one.
Disposable masks can also cause irritation and inflammation, but are safer as they have to be changed more often and discarded after use. Respiratory masks (for example, model 95) are more reliable in protecting against coronavirus, but, in turn, squeeze the area of ​​the bridge of the nose and under the eyes, causing irritation. And of course, change your mask regularly. If the mask is disposable, do it every two hours, it is better to change the reusable one during the day (and wash at home).
 
How to treat maskne?
If inflammation and irritation have already begun, you should add cleansers with anti-inflammatory and soothing ingredients for daily skin care (for example, retinoids: Tretinoin, Adapalen; antimicrobial agent: benzoyl peroxide)
Retinoids are comedolytic agents that normalize desquamation in the follicular infundibulum and have an anti-inflammatory effect. In the US, 3 retinoids are used to treat acne: tretinoin, adapalene, and tazarotene.
Tretinoin
Monotherapy - 0.025% tretinoin gel reduced the amount of microcomedones by 40% for 84 days.
Follicular biopsy - 0.1% tretinoin cream reduced microcomedones by 50% at 6 weeks and 80% at 12 weeks.
Standard tretinoin preparations cannot be used concomitantly with benzoyl peroxide.
Adapalen
Comparative studies - Adapalene 0.1% gel has the same efficacy as 0.025% tretinoin gel, but has a better safety profile.
A randomized trial - adapalene 0.3% gel was more effective than 0.1% adapalene gel (reducing the total number of acne by 45.3% and 41.8%, respectively).
Adapalene is lightfast and can be used with benzoyl peroxide. Combinations of 0.3% adapalene and 2.5% benzoyl peroxide gel showed higher efficacy.
Tazarotene
0.1% tazarotene gel is superior to 0.1% adapalene gel and 0.1% tretinoin gel, however tazarotene is strictly prohibited for pregnant and breastfeeding women.
It should be remembered that all retinoids have a slight photosensitizing effect, therefore the combined use of sunscreen is necessary.
Antimicrobial agents
Benzoyl peroxide is effective in reducing C. acnes concentration by releasing oxygen free radicals without causing microbial resistance. Higher concentrations (eg 10% versus 5%) can lead to increased irritation without significantly improving the antimicrobial effect. Antibiotics, primarily clindamycin and erythromycin, also reduce C. acnes. However, bacterial resistance is widespread. Thus, antibiotics should not be used as monotherapy - only in combination with other agents.
The combination of benzoyl peroxide with a topical antibiotic reduces the concentration of antibiotic-resistant C. acnes strains and is more effective.
Other topical drugs
Dapsone gel 5% (for the treatment of leprosy) has clinical efficacy for patients with inflammatory acne. The gel is used as a "first line" therapy for patients with sensitive skin, women with acne with darker skin tones. Glucose-6-phosphate dehydrogenase testing is not necessary with topical dapsone gel, even in high-risk groups.
Azelaic (dicarboxylic) acid is used in acne patients primarily for its ability to reduce post-inflammatory hyperpigmentation and may also be beneficial for patients with mild inflammatory and comedonal acne. Azelaic acid alters abnormal keratinization and inhibits the growth of C. acnes.
Despite very limited clinical data, salicylic acid, a comedolytic agent, is widely available for the treatment of acne. It is believed to be less effective than topical retinoids, but has an acceptable safety profile.
Use mild exfoliants (exfoliators) several times a week to remove dead skin cells and prevent new inflammation. The inflammations themselves can be treated with anti-inflammatory drugs. It is important not to overdry the skin.
Monitor skin hydration carefully. You can choose a moisturizer with anti-inflammatory ingredients (for example, chitosan, hyaluronic acid, sodium alginate). For example, with niacinamide - it rebuilds the skin barrier by promoting the production of ceramides - proteins that hold water in the skin.
 
Why are antibiotics ineffective and if there are alternative preparations for acne treatment?
Acne vulgaris is one of the most typical skin diseases, affecting approximately 80% of adults aged from 11 to 30 years. There are several significant factors causing acne in people such as skin pathogenic bacteria, keratinization of the follicle, and increase in sebum secretion. Although it is not life threatening, it can cause a permanent scar and also negatively affects psychological developments, resulting in a severe emotional scar, which may lead to clinical depression and social phobias. It has been known that Staphylococcus epidermidis, Propionibacterium acnes, Staphylococcus aureus, Pseudomonas aeruginosa, and Candida albicans are skin pathogens associated with the development of abnormal follicular keratinization and inflammation. Among a variety of factors contributing to the development of acne vulgaris, bacterium P. acnes is the main factor in the pathogenesis of acne vulgaris. In general, topical therapies for acne vulgaris, including retinoide, benzoyl peroxide, and antibiotics, have been used to improve the control of moderate acne. As described, an antibiotic application for treating acne vulgaris is usually used to kill acne-related bacteria. Among the various antibiotics, tetracycline, erythromycin, and lincomycin are commonly taken for the antibiotic therapy. However, treatment by antibiotics and benzoyl peroxide, used to treat acne vulgaris, normally causes several side effects such as the emergence of resistant bacteria, immune hypersensitivity, and organ damage in the case of using those medicines for a long period; moreover, they are toxic to human cells. Therefore, recent researches have focused on the development of alternative therapeutic substance with less adverse and strong antibacterial effects.
 
Microbioserum Research
Propolis
Preparation containing propolis is more effective in reducing acne compared to the preparation of synthetic origin such as erythromycin. In addition, the preparation based on natural product has been shown to have greater function in reducing erythema.
Chitosan
We investigated the antibacterial activities of chitosan succinate against acne-related bacteria, particularly Propionibacterium acnes. Chitosan succinate showed potent antibacterial effect on P. acnes. Especially, chitosan succinate presented the highest antimicrobial effect with minimum inhibitory concentration values of 30-40 μg/mL on P. acnes. In addition, chitosan succinate clearly reversed the antibacterial effect of tetracycline and erythromycin on P. acnes in the combination mode. The supramolecular complexes tetracycline/erythromycine and chitosan succinate resulted in a median ΣFIC range of 0.02–0.56, suggesting that the antibiotics-chitosan succinate combination resulted in an antibacterial synergy against P. acnes. Thus, the results obtained in this research strongly supported that erythromycin and tetracycline will restore the antibacterial activity against P. acnes in the combination mode with chitosan succinate.
 
Microbioserum preparations for the prevention and treatment of maskne (acne)

T1 alcohol-free tonic (anti-inflammatory)
Keratinase B - cleansing mask (antibacterial)
Propolis-PP - antibacterial preparation with propolis against acne, fungal infections and healing of closed wounds and abrasions
Microbiome-S - complex of coumarins and polyphenols from fungal mycelium to restore microflora and protective functions of the skin (skin microbiome)
Scar Treatment enzyme complex - enzyme preparation with keratinase, collagenase - correction of post-acne, hypertrophic and keloid scars, stretch marks
Chitosan hydrogel - hydrogel system based on chitosan for diluting concentrates, prolonged release of bioactive ingredients, moisturizing the skin