Red-faced: Masks are causing rosacea, aggravating teen acne

The mask mandate was only in place a few weeks when Michelle Roth started seeing an explosion in red faces and acne.

Roth is a physician assistant at Soderstrom Skin Institute, and she said the growing volume of skin disorders is both directly and indirectly linked to the COVID-19 pandemic. The direct cause is masks: Covering our faces hasn’t done our skin any favors. Indirectly, the stress of the pandemic is aggravating skin troubles.

Roth herself has battled rosacea, a condition that causes redness and makes the blood vessels visible in the face. Older generations would disapprovingly mutter the words “gin blossoms,” but rosacea is tied to other risk factors apart from alcohol.

“It’s frustrating,” Roth said. “I’ve even experienced it personally on my chin and jaw line. It’s hard to escape it, even if you’re using the best masks or the best routines. You still can potentially flare up.”

Dermatologists are by no means anti-mask – they want to avert COVID-19 as much as anyone – but those interviewed acknowledged that continual mask usage has set off an explosion of rosacea in adults while aggravating acne in teenagers.

“I would say it’s tripled, for sure,” Douglas Leone of the Dermatology and MOHS Surgery Institute said. “I’ve had adults who haven’t had acne for years now suddenly having breakouts.”

Leone observed that infection controls weren’t in place long before he started seeing an influx of patients complaining of inflamed skin and pimples that didn’t respond to over-the-counter products.

“I think the rosacea and the irritation showed up fairly quickly, like in the first month or so,” he said. “Acne is always a bit delayed, probably three months later, but there’s definitely been an increase in prevalence.”

Tight-fitting masks reduce coronavirus transmission, but they also cause irritation and prevent the skin from breathing, so to speak. Roth said she sees student-athletes playing sports in masks – which, again, is prudent – but nonetheless can aggravate acne.

“Masks need to be well-fitting,” Roth said, “but the heat and moisture they create tends to exacerbate rosacea and acne.”

Roth said facial coverings may be the prime suspect, but there are other risk factors in play during the pandemic. Extreme cold and heat can cause rosacea flare-ups and so can alcohol, which has been a popular stress-buster during the pandemic. Stress is a proven menace to the skin, and the pandemic has produced no shortage of stress.

Acne and rosacea can be prevented using mild cleansers and moisturizers, provided users steer clear of scented varieties, as fragrances can irritate the skin. Sunscreen is strongly recommended, as direct sunlight is linked to acne and rosacea.

Men are advised to shave with a good lather, working the blade in a single direction. Leone also advised men to steer clear of after-shaves, as they can dry out the skin and aggravate conditions such as rosacea.

Indeed, dryness is such a problem during the winter months that Leone strongly recommends using a humidifier in the bedroom, giving the skin some much-needed moisture overnight.

Before leaving for work or school, people should also apply moisturizers that don’t clog pores. Products containing benzoyl peroxide are helpful, but Leone recommended low-strength products with benzoyl concentrations of 2.5% to 5%.

“Anything higher than that and it’ll dry out the skin,” he said.

Women generally are more at risk of rosacea, particularly those who are fair-skinned, older than 30, who smoke or have a family history of rosacea.

Both conditions can be stubborn, and prescription treatments may be the best – and in some cases, the only – source or relief.

The Mayo Clinic said mild cases may call for a cream or gel applied to the affected skin. Brimonidine (sold under the brand name Mirvaso) and oxymetazoline (brand name Rhofade) reduce redness by constricting blood vessels, with results sometimes reported within 12 hours of use.

“The effect on the blood vessels is temporary,” according to the Mayo Clinic, “so the medication needs to be applied regularly to maintain improvements.”

Other drugs will control pimples, such as azelaic acid (Azelex, Finacea), metronidazole (Metrogel, Noritate, etc.) and ivermectin (Soolantra). Users need to be patient: Azelaic acid and metronidazole typically require two to six weeks for visible results. Ivermectin may take even longer to improve skin, but it also yields longer remission periods.

Severe cases may require oral antibiotics such as doxycycline (Oracea is among the brand names) for acne or isotretinoin (Amnesteem, Claravis, etc.) for severe rosacea.

And keep an eye on your eyes. While not common, there is a condition known as ocular rosacea in which patients experience dry, irritated, swollen eyes and red, swollen eyelids.

No, wearing a mask will not induce ocular rosacea. However, Joseph “Barry” Jackson, an optometrist with Bard Optical in Peru, said ocular rosacea is known to precede acne rosacea.

“Those patients with ocular rosacea should be on the lookout for this because they have a higher incidence of acne rosacea,” Jackson said.