Maskacne

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).

Reference:
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.
Conclusion: 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