Monday, February 01, 2021


Then felt I like some watcher of the skies
When a new planet swims unto his ken…


The patient is a 35 yo OB/Gyn junior faculty with a 2 month history of “Maskacne.”  She uses a standard surgical mask for ~ 12 hrs a day. Her skin care regimen is: “wash with Aveno cleanser, apply Cerave moisturizer. If going out will apply Shiseido sunscreen as well. I try not to wear makeup under mask, but if I do it will be Tarte foundation and a blush
Night time: wash with Avene cleanser, sometimes apply toner, and followed by Cerave moisturizer."

Prior to Covid 19 she only used a mask in the OR and Labour & Delivery room but for the past 10 months she’s been masked 10 – 16 hrs a day.

O/E: Papules and pustules on the lower face.

 Diagnosis:  Acneiform eruption under a mask in a young woman with no previous history of inflammatory acne.

In the Differential Dx
1) Perioral dermatitis
2) Demodex folliculitis
3) Oil acne/Occlusive acne
4) Acne mechanica  (A report from the BMJ in 1976 is helpful.  Strangely, this entity has been understudied)

Has any reader had experience with Maskacne?  Your thoughts will be appreciated.

Addendum: I week after posting the patient writes "I just cleaned face without moisturizers this past week and it is improving everyday. Still doesn’t look great but the pustules are gone (photos below).

1. Yu J, et. al. Occupational dermatitis to facial personal protective equipment in health care workers: A systematic review J Am Acad Dermatol. 2021 Feb;84(2):486-494. PMC Full Text.

2. Jillson OF, Perioral dermatitis. Cutis 1984 Nov;34(5):457-8.

3. Khalifa E Sharquie  et. al. Topical therapy of acne vulgaris using 2% tea lotion in comparison with 5% zinc sulphate solution. Saudi Med J. 2008 Dec;29(12):1757-61. PMID. (See Prof. Sharquie's comment on this patient.
Two percent tea lotion was a good alternative remedy to be used in the treatment of acne vulgaris, and was much superior than topical 5% zinc sulphate solution.

4. Acne mechanica. BMJ 1976 Jan 17;1(6002):130.  PMC1638630 Free Full Text


  1. I am seeing this in many patients. Two types-exacerbation of cystic acne and others who develop new fine pustules and pinpoint papules.
    I think the second one is demodex related and responds great to triple cream -ivermectin, metronidazole, azelaic acid combination ordered through skin for 45.00.
    I haven’t had acne in 45 years snd personally developed the second kind after weeks of wearing my mask 6-8 hours a day.

  2. From Prof. K.E. Sharquie, Baghdad, Iraq: "This is one of the commonest face rash that is seen in every day practice.Any ointment or cram that are applied on susceptible skin like adolescent skin might induce this rash.The commonest offending agents are makeup,steroid drugs,sunscreens,emollients,masks etc.Also we should not forget hair epilations by thread or wax also commonly followed by acneform rash in acne susceptible individuals."

  3. From Rob Shapiro, Hilo, Hawaii: "Robert Shapiro

    9:50 AM (6 minutes ago)

    to me
    Excellent case and comments.

    I look at it similar to occlusion acne like what occurs under the shoulder pads in high school football players. Occlusion acne has no cure until the occlusion is removed. Treating occlusion acne on the shoulders of high school football players wearing shoulder pads for hours while sweating in the hot sun is not treatable

    Why does she have to wear makeup and expensive heavily promoted unnecessary moisturizers under her mask

    Using a toner and then a moisturizer is like running the humidifier simultaneously with the dehumidifier in your house.

    I judge the intelligence of dermatologists depending on if they recommend highly pharma products or think on their own. I saw a propaganda movie about chiropractors. In it a former pharmaceutical executive admits the pharmaceutical industry views their target physicians as prostitutes.

    Stopping her current regimen and using a mild wash off topical GENERIC otc benzoyl peroxide and a topical antibiotic would be a start. Once or twice a week topical GENERIC retinoid might be all she needs. Stop the vicious cycle of toner followed by moisturizer. That is an insane trope invented to sell more unnecessary products. Like a 7 step regimen. It’s abusive. Noone has shown cerave cream to be more effective than any generic moisturizer or vaseline for that matter there’s so much money being wasted and falsehoods and misleading commercial promotion going on here. It needs to be called out.

  4. From Dr. Marius Rademaker, Hamilton, NZ: "Mask acne is interesting. Causality is difficulty as the chin is such a common area for acne in younger women. I’ve always had a casual thought whether the mechanical trauma of the skin moving over the mandible as women talk has a role to play. Note: the concept doesn’t go down well with the women I’ve asked! Another casual thought is whether women rub their jawline more than men, but despite years of casual observations, I don’t think this is the case. I think that a more important physical factor is pore size being smaller in women, with pro-inflammatory menstrual fluctuations leading to clinically relevant comedogenesis. Who knows! I’m a believer in stress-associated release of inflammatory mediators associated acne, as well as humidity-associated aggravation of acne, so the current environment of mask wearing has several possible causal explanations.

    With regards mechanical acne, I have definitely seen this on the forehead, chin, neck, shoulders and wrists from rubbing (usually with sweat/heat) from the wearing of helmets, chin straps, backpack straps, etc. It is usually non-cystic though."

  5. Prof. Bhushan KumarFebruary 03, 2021

    Occlusive acne (due to Mask). Worsened by gram negative infection.


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