With all of this nonsense going on, why do we have to experience acne as well?

Dermatologists are seeing a rise in the number of people with acne during the pandemic. This flare-up in acne occurs in both people who have had acne problems in the past, are now flaring up, and those who are usually unaffected. It seems to be worse on the lower part of the face in the area covered by a mask.

There are several reasons for these acne flares.

We have to deal with the usual adult (women especially) acne due to hormones and just the unfairness of life, but now we are all breaking out from wearing masks. Added are hormonal changes from the stress of all of this nonsense going on right now - the shutdowns, worrying about our jobs, infection risk, and financial disaster.

Why is there an increase in acne right now? Three reasons: Occlusion, Moisture, and Stress.

Occlusion and Moisture Cause Acne

To understand why this is a problem, you have to understand what causes acne and how it forms at a microscopic level in the skin. We have hair follicles all over the body, except for the palms and soles. The hair root grows the hair, which exits the skin's dermal layer through the epidermis as a pore. Some of the hairs are larger and thicker, like on the scalp and beard. Some of the hairs are very tiny and almost invisible. There are oil glands attached to the side of the hair follicles that are supposed to drain oil to the skin's surface by the same pore. The purpose is to keep it supple and protect the skin barrier, just like oiling leather shoes. There are also eccrine sweat glands that drain to the skin's surface by a separate duct or pore to help regulate body temperature.

Acne occurs when the follicles (pores) get plugged with cells. These cells are supposed to shed and fall off the surface of the skin. Acne starts when the cells don't exfoliate naturally and plug up the pore. Sometimes you can see this as a blackhead or whitehead. But even if you can't see them, because they are deeper in the pore, they block the normal flow of oil from the oil gland to the surface of the skin. If the oil gland can't drain properly, it explodes just like a balloon. And that releases oil, dead skin cells, bacteria, and other substances into the skin's dermis. Those substances are not supposed to be free in the skin; they are supposed to stay in the oil gland and the pore. Your body thinks something terrible is going on and sends white blood cells and inflammatory mediators to clean up the toxic spill.

And that leads to pus. Then your body wants to get that pus and toxic products out of there, and it forms a collection of pus, what we call consolidation. That consolidation of pus ideally rises to the skin's surface, and you see it as what we charmingly call a "pus cap." It is then extruded to the surface of the skin and eliminated. Problem solved!

If you are wearing a mask, especially if you are wearing it for long periods, there is a problem with heat, moisture, and friction. Body heat is trapped, your breath is moist, and you are sweating. Warm water causes swelling of the skin, just like when you go into a steam room and come out, and your skin looks lovely and plump. But it swells the skin around the opening of the pores so they may become blocked. And when they become clogged, acne can occur. And a warm, moist environment is a suitable environment for the bacteria Cutibacterium acnes (formerly Propionibacterium acnes) that is part of the pathogenesis of acne.

Occlusion, which traps moisture, also is a problem because of friction and rubbing. That friction, combined with water, irritates the follicular opening, causes it to be blocked, and worsens the situation. Dermatologists have seen this for years in our athletic patients who have "aerobic acne" in those who work out or participate in sports developing acne under their sweaty T-shirts or bras, sports helmets, chin straps, and shoulder pads.

So, occlusion and warm moisture under the mask is a problem.

Stress Causes Acne

Stress causes acne. Everyone stressed right now. Stress hormones, like cortisol, increase when the body is under pressure. That increases the incidence of acne. Male-type hormones (Testosterone) increase when we are under stress, as our stone-age bodies are programmed to release stress hormones in response to try to help with an emergency response to that Sabertooth tiger that is going to kill us. Even when things are not a direct and immediate physical threat to us, our pre-historic defense is to release the hormones that will help us survive right now. Unfortunately, those defense mechanisms have downsides. One of them is acne. It is a complicated topic; for more info, see more about hormones, women, acne, and the unfairness of life in my post: Open Pandora's Box: Hormones, Women, and Acne

Women Pick at Acne When They are Stressed

I know it is sexist to say this. I am a woman, and I mess with stuff on my face when I am under stress. Own it. Stop it. It is never a helpful response. Get rid of the magnifying mirror, lock it up, or ask a responsible person to keep it from you. See my post: Step Away from the Magnifying Mirror, Ma'am

So how can we reduce or prevent mask related acne? What can you do on your own to minimize mask-related acne (Maskne/Mask-ne) or just regular garden variety acne?

Tips to Treat Acne Right Now Without a Physician

• Clean mask and change masks often if you can. Wash your cloth masks frequently. Take them off when you can, safely.

• Wash your face sometime during the day. Either use a gentle cleanser if you have sensitive or dry skin or use a good acne cleanser with salicylic acid for normal or oily skin. The salicylic acid helps clean out the pores.

• Don't wear as many skincare products as you usually do; simplify your routine. Layering a lot of skincare products on your skin increases the occlusion, which increases acne. Use non-acnegenic, non-comedogenic skincare products. Look for those that are tested and labeled as such.

• Don't wear a long-wearing or "all-day" foundation. These, along with waterproof or sweatproof sunscreen, are always a problem for people prone to acne because they can plug pores. What makes these products stick to the skin and stay on for a long time, adheres to the pores. If you can, especially if you are wearing a mask all day, don't use a liquid foundation. No one sees anything under your mask anyway.

• Good quality acne skincare helps. Look for cleansers, masks, and leave-on products with either salicylic or glycolic acid.

• Over the counter or non-prescription acne medications or treatments can help too. You can buy over the counter adapalene, a retinoid with the same ingredient in prescription Differin. Retinoids work by helping the skin cells around the pore opening to shed naturally and not block it. Over the counter benzoyl peroxide helps reduce surface Cutibacterium acnes bacteria. Both can be somewhat drying and irritating, so don't overdo it.

Sometimes You Need Professional Help With Acne

Obviously, I am biased, but I believe a board-certified dermatologist is the best one to help you with your acne.

See your dermatologist for prescription treatment. Antibiotic wipes like Clindamycin pads are convenient to use in the middle of the day and after workouts or sports to remove sweat, oil and leave a layer of antibiotic on the skin. Prescription retinoids like Retin-A (tretinoin), Differin (adapalene), Tazorac (tazarotene), or Aklief (trifarotene) help reprogram the cells in the follicle to shed correctly. Oral antibiotics help reduce the Cutibacterium acnes bacteria and also have an anti-inflammatory effect.

Certain birth control pills and or Spironolactone can be beneficial for women but can take months to show results.

More about birth control pills in the treatment of acne at my post: The Best Birth Control Pills for the Treatment of Acne in Women

More about Spironolactone at my post: Beyond Birth Control Pills for Acne in Women

In-office glycolic or salicylic acid peels, every 2-4 weeks followed by acne surgery by trained RN's can be very helpful.

Remember:

• Use the treatment all over the areas affected by acne. Don't just spot treat. We are trying to prevent a new pimple two months from now, not only dry out the one already there.

• More is not better. Use the directed amount; extra will dry you out and irritate your skin, not make you better.

• Be patient. It takes at least two months to see results. You won't be better by this weekend. People tend to be pretty good for a couple of weeks and then get frustrated and give up. Don't give up.

• Don't spot treat as your only method of treating. You can spot-treat a little extra to a pimple to dry it out but in moderation, or all you will get is an irritated, red, peeling mess.

• Don't stop using your medicine once you get better. You will flare up again in a couple of weeks or a month. Treatment of acne is not a cure; it is to control it.

Hope for Acne Treatment

Hopefully, this pandemic and the need to wear masks will be over sometime in the reasonably near future, and we can go back to something approaching normal. Then we can go back to dealing with every day, frustrating, aggravating, irritating acne that we all hate.