Dr. Alina Sholar shares tips for fighting maskne and keeping your skin healthy.

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Dr. Alina Sholar
Dr. Alina Sholar

Take it from a surgeon: I know how to rock a mask all day. Due to unfortunate current circumstances, wearing a face mask is now part of everyday life for many of you, too, and for most, this can lead to skin irritation, post-inflammatory hyperpigmentation, breakouts, impetigo, eczema, rosacea or perioral dermatitis. This is collectively and colloquially known as maskne and it all starts with iso skin. Conversations in my practice about acne and inflammatory skin conditions have hit an all-time high in the last few months. That’s because masks worsen skin issues and cause new ones. 

Basically, isolation skin (aka iso skin) is when our skin changes as a result of our changing lifestyles and emotional well-being amid quarantine for COVID-19. Just as we’re trying to make sense of how SARS-CoV2 is impacting our livelihoods, daily routines, work, finances, relationships and physical and psychological health, our skin is kind of confused, too.  For some, isolation skin looks like angry hormonal acne or pimples in places you don’t normally get pimples. Others will find they keep breaking out in a rash, or their rosacea, redness or sensitivity is flaring up frequently, or even constantly. 

Let’s get to the root causes of maskne and iso skin.

1. Increased stress 

Stress is a major cause of inflammatory skin conditions because it creates an increased production of cortisol, a type of steroid hormone that can cause breakouts and rough-textured skin. Stress causes inflammation in the body, which can even manifest as rosacea flare-ups, acne flare-ups, IBS and other gut issues. Elevated cortisol levels also affect the composition of the gut’s microbial ecosystem and increase gut permeability, which is reflected on the skin surface as diminished skin-barrier function, increased inflammation and increased transepidermal water loss and skin dehydration. Unconscious stress counts, too. Whether you realize it, small changes in our lifestyles, like not being able to see our besties, feeling restricted to your home and general anxieties about what we can and can’t do, are stressful and can impact your skin in major ways. 

2. Loss of our daily routine

Losing our usual daily routines makes it more difficult to maintain a healthy diet, go to the gym and stay on a healthy sleep schedule.

People are also getting much more exposure to aging and inflammation-inducing free radicals—particularly blue light—as we’re living in front of our computers and television screens day in and day out. 

Being in isolation may have led to more takeout, fast food, sugary snacks and alcohol consumption than you would normally have had in your diet and, unfortunately for your skin, less skin-loving fruits, vegetables and healthier fats. Not only does your skin start missing essential nutrients, it becomes more sensitive and more prone to inflammatory conditions like mask-related acne and dermatitis. Again, much of this is due to alterations in gut function that ultimately affect the health of the skin. A sustained rise in insulin levels from poor dietary habits makes gut motility slower which, along with the hormonal imbalances from stress, cause the gastrointestinal tract microbiota to shift toward an unhealthy and inflammation-inducing trajectory, again affecting the skin. Further, sugars cause glycation of the collagen and the microscopic, nourishing blood vessels in your skin, making your skin more aged and less plump and youthful. 

At least 30 minutes of some exercise daily is also important to the wellbeing of our skin and supports good all-round health.

Sleep plays a major role in skin health, too. Your skin replenishes its youthful collagen at night when your brain releases growth hormones to stimulate fibroblast cells to churn out these vital proteins, along with elastin and hyaluronic acid. Without your “beauty sleep,” skin appears dull and lackluster because cellular turnover—the process of desquamation (natural exfoliation) and replacement—is slowed drastically. 

3.  Skipping healthy skin hygiene

Your first instinct when we went into quarantine probably was to throw up your hair in a messy bun, leave the makeup on the shelf and skip the nighttime beauty routine. Especially as the quarantine drags on, I have seen a number of patients who have gone days without washing their face and, if they are lucky, it only shows up as oil and skin debris clogging pores, a dull appearance and a rough texture. For many, though, their skin’s health pays a longer-term price for going without proper, regimented skin care. The skin requires a proper pH to function optimally, and cleanser sets the pH. Cleansing not only prepares the facial skin to allow active ingredients in corrective products to perform in optimum fashion, but it also enhances its ability to stimulate collagen production, affect cell turnover, and to improve your color and texture. Even if you don’t follow a 12-step product routine, you should at least cleanse and apply a barrier-repairing hydrator twice daily.

4.  Mask manifestations

Maskne—the most common kind is acne mechanica aka the type of acne a football player may get where the helmet rubsis so prevalent that the COVID-19 task force of the American Academy of Dermatology (AAD) felt compelled to release advice on the subject. Moisture and friction cause the majority of maskne problems. Masks trap excess moisture within the enclosed space between a person’s face and the fabric, raising the bacterial count on the skin surface, leading to acne and inflammation. Add to this the friction of the mask against the skin, especially across the nose, cheek and behind the ears. Due to both higher humidity and constant mask rubbing, the barrier of the skin becomes disrupted and the skin develops tiny cracks in its surface, which opens it up to the influx of pathogens. This can trigger acne, rosacea and perioral dermatitis around the mouth in an individual who may be predisposed to developing it. Even after inflammation subsides, one may be left with long-term hyperpigmentation. I advise against wearing any coverings that might have synthetic fibers, like polyester or spandex. Much better on the skin are at least 600-thread count, two-layer masks made out of natural fibers, such as cotton, bamboo or natural silk to reduce the likelihood of irritation. Plus, you need to treat it like underwear and wash it after you’re done wearing it for the day. All the oil, sweat, dirt, makeup, and not to mention, bacteria and viruses create havoc on the skin when reapplying it with a dirty mask.

To help keep the healthy microbiome of the skin in balance and pathogenic bacteria in check, you should wash your face with a gentle, non-foaming, pH-balanced, medical-grade cleanser. Before you go out during the day, put on a barrier-repair moisturizer (I prefer Dermaviduals) then sunblock, followed by your mask. Don’t touch the outside of your mask, since you will contaminate your hands from the outside of the mask, then contaminate your skin.

5.  Skin DIYs. 

While it might have been kind of fun and novel at the beginning of the quarantine to give ourselves a home facial, it may not have been under the advice of a clinician to ensure it was the correct treatment for our own skin condition. Many of the skin issues we are seeing today in my office are the result of use of poor quality or improper products.

Or, you may have been initially prescribed beauty treatments such as peels and dermal rollers for home use but using these treatments for a prolonged period of time without continued direction from a professional can be detrimental to your skin. To make matters worse, in patients experiencing maskne, they are too often using over-the-counter acne products which can make many of these skin conditions much, much worse. 

A professional skin consultation known as the SkinRx should be the first step you take when you’re considering restarting treatments or skin care. The process allows you to gain advice from us on what is best for your individual needs and concerns. We recommend skin consultations to everyone now that we are easing out of the isolation routine. It’s the only way to provide you with expert advice and help you achieve your desired results.

Our clinics follow a skin consultation process before any treatments are conducted to ensure your treatment is bespoke and customized especially for your individual skin’s needs.

Step 1: The SkinRx Biometric Skin Analysis and Exam Our skin therapists take complimentary skin-analysis photographs using their Observ and Vectra analyzers and the Dermalab biometric measurement device. The SkinRx is done for every new and existing client, and is a great way to see the progression of your skin with use of our recommended products and treatments.

Step 2: The DermaDiscussion This step is the most important for your skin therapist, this is where they are able to connect with you and discover your skin’s needs and requirements. They will discuss your skin history, health, diet, lifestyle, current skin-care routine (or what you had adapted to during quarantine) and several other factors that could be contributing to any skin issues you may be currently experiencing. This time gives your skin therapist an indication of how you are currently looking after your skin, what could be causing certain concerns and any medication you are using that may impact your skin’s condition. They may well be interested to find out about your own at-home skin routine! They get to know you and your skin here.

Step 3: Our PrettySmart Bespoke Treatment Plan Skin consultations can be overwhelming. Our clinics always approach the skin from a 360-degree standpoint, which allows them to achieve the best results, but it can be a lot to take in on your first visit. To make this process easier for you, they record everything you have discussed during your consult. You will receive home-tailored, skin-treatment recommendations, maskne essentials and any lifestyle and/or diet changes discussed and recommended. We get to know our patients and aim to achieve your skin goals together. 

Book an appointment with Dr. Alina Sholar at skinsciencesoul.com.

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