Lancaster Physician Winter 2021 - 25

Simplify your regimen. Wash your face with
a gentle cleanser and rinse with lukewarm
water before and after you wear your mask.
Apply a moisturizer that contains ceramides,
dimethicone, or hyaluronic acid to protect
from mask friction. Make sure to wash and
moisturize your face at least one hour prior to
donning personal protective equipment and
avoid petrolatum products as these can interfere
with masks, especially N95s. Steer clear of products containing fragrances, hydroxy acids, and
retinoids because masks will intensify any skin
care treatment's active ingredient delivery into
your skin. If you do use active ingredients, use
them at night or prior to bed. Wearing makeup
under your mask will further clog your pores
and exacerbate acne flares. Leave the makeup for
mask-free Zoom calls at home, or wear a light,
non-comedogenic, oil-free tinted sunscreen.
It's important to identify and treat any skincare issues caused by masks. Acne mechanica is
characterized by open and closed pores, pustules,
or nodulocystic lesions, especially in the area
under the mask. Follicular based pustules, especially in the beard area, are found in folliculitis.
For these conditions, use a 2.5 percent or 5 percent benzoyl peroxide product for spot treatment
or similar concentration wash for cleansing. A 2
percent salicylic acid wash helps to treat clogged
pores, and glycolic acid wash can be used to treat
post inflammatory hyperpigmentation. When
initiating a nighttime retinoid, use a pea-sized
amount, every other night, and cover it with a
moisturizer to mitigate irritation and dryness.
If your facial acne continues to flare, topical
and oral antibiotics or oral retinoids can treat
pimples, pustules, and nodules.
Deeper nodulocystic acne on the lower third
of the face, particularly on the chin, jawline,
and neck in females, can commonly be seen in
hormonal female acne. This condition is often
exacerbated by stress, hormonal changes, and
friction. Spironolactone and oral contraceptives
are key treatments.

small, erythematous papules around the nose,
mouth, and/or eyes, sometimes accompanied
by eczematous patches. Use gentle, sensitive skin
care products. Look for active ingredients such as
niacinamide, azelaic acid, zinc, and prescription
treatments including topical metronidazole,
alpha 2-adrenergic receptor agonist, calcineurin
inhibitor, ivermectin, or oral doxycycline.
Seborrheic dermatitis causes yellow, greasy
red patches on the forehead, eyebrows, and
nasolabial folds. Use a dandruff shampoo
containing zinc pyrithione, ketoconazole,
or selenium sulfide. Over the counter mild
topical steroids can be used sparingly for
very inflamed and itchy patches.
Eczematous eruptions from masks can
be caused by dryness and irritation. Take
note if your face is very itchy and red or
becomes red in a particular geographic
area like the nasal bridge underlying a
foam nose piece or behind the ear from
elastic straps. Allergic contact dermatitis
from mask components (such as metal nose
pieces or clips, rubber, dyes, or fabrics containing
allergens like formaldehyde and polypropylene)
has been increasing in health care workers
around the world. Switch your mask, use a
barrier cream prior to wearing your mask, and
use a topical steroid. If the issue persists, consult
a dermatologist or allergist to investigate further
with formal patch testing.
Be protective, proactive, gentle, and don't just
cover up your maskne! Scarring and post-inflammatory pigmentary changes can persist even after
mask mandates are over. If you need a stronger
regimen, don't hesitate to ask your primary care
provider or dermatologist for help!

Rosacea manifests as flushing, erythema,
and broken blood vessels on the nose, cheeks,
chin with papules or pustules. Periorificial (or
perioral) dermatitis is a variant of rosacea with

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Lancaster Physician Winter 2021

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