The “Maskne” microbiome – pathophysiology and therapeutics

Abstract

“Maskne” is a new term coined during the 2020 COVID‐19 pandemic. It refers to a subset of acne mechanica, deserving consideration in view of widespread reusable fabric mask‐wearing to control the pandemic worldwide. Understanding of underlying pathophysiology directly relates to the novel skin microenvironment and textile–skin friction created by mask‐wearing, distinct from nontextile‐related acne mechanica previously linked to wearing of headgear. Specifically, the occlusive microenvironment leads to microbiome dysbiosis, which is linked to various dermatological conditions. Additional textile–skin interactions include factors such as breathability, stickiness sensations, moisture saturation, and hygiene maintenance. Increased skin temperatures can trigger sweat/heat‐related dermatoses, and ear loops potentially trigger pressure‐induced dermatoses. Important therapeutic considerations include increased skin irritation potential of conventional acne treatments under occlusion, exacerbation of chronic dermatoses, that is, perioral dermatitis, rosacea, and eczema, and susceptibility of these same patient groups to heightened discomfort with mask‐wearing. Cotton, as the traditional fabric of choice for dermatology patients, has limited benefits in the context of face masks – increased subjective discomfort relates to increased moisture saturation and stickiness, inevitable because of high biofluid load of the nasal and oral orifices. Prolonged textile–skin contact time, directly proportional to the risk of maskne, can be an opportunity for the application of biofunctional textiles.

Opinions of clients of cosmetology salons regarding the impact of wearing protective masks on the condition of the skin

“…An important factor influencing the composition of the microbiome is water, which determines the increase in the number of microorganisms, therefore, in areas with high humidity, numerous commensal microflora is observed. Microflora dispersion leads to the division of pathogenic and virulent strains of C. acnes, and also activates the innate immunity causing skin inflammation [6].…”

“…A warm and humid microenvironment created by wearing masks increases the skin's susceptibility to fungal infections, for instance candidiasis and malassezia, which are common commensals of healthy skin. Wearing masks affects the infection of the skin with microorganisms that colonize wet areas, such as Staphylococcus and Corynebacteria [6].…”

Cutaneous coronavirus disease 2019 in children: a clinical primer for diagnosis and treatment

“…’Maskne’ is a term describing a form of acne mechanica that has recently come to the forefront of dermatology due to the COVID-19 pandemic [ 76 ▪ ]. The skin microbiome must be in balance to have healthy skin.…”

Design elements in face masks can provide an effective fit to prevent droplet spread: A reply to “Importance of nose wires in face masks”

“…The purpose of recommending wearing mask in public must be clearly defined, ie, to limit the environmental spread of biofluids, 2 which impact viral load or the risk of infectivity via airborne transmission. 3 The inherent protective value (against infection) of wearing individual fabric mask in a non-N95/full personal protective equipment setting must be carefully considered.…”

“…Biofunctional textiles can destabilize infectious viral droplet nuclei via biocidal effects, 5,6 thereby reducing fomite contagion. Correct storage or handling must be emphasized, 2 while addressing its practicalities in a layperson context. The added value of wired masks should be researched in the context of aerodynamic models measuring the droplet trajectories while speaking.…”