Acne flare-up due to mask wearing: A current pandemic scenario and its relationship with sleep

Facial Dermatoses Associated With Mask-Wearing in the COVID-19 Era: A Nationwide, Cross-Sectional, Multicenter, Questionnaire-based Study

BACKGROUND

Daily usage of facial masks during coronavirus disease 2019 pandemic influenced on facial dermatoses.

OBJECTIVE

This study investigated the impact of mask-wearing habits on facial dermatoses.

METHODS

A nationwide, observational, questionnaire-based survey was conducted from July through August 2021, involving 20 hospitals in Korea.

RESULTS

Among 1,958 facial dermatoses, 75.9% of patients experienced aggravation or development of new-onset facial dermatoses after wearing masks. In aggravated or newly developed acne patients (543 out of 743), associated factors were healthcare provider, female gender, and a long duration of mask-wearing. Irritating symptoms, xerosis, and hyperpigmentation were more frequently observed in this group. Aggravated or newly developed rosacea patients (515 out of 660) were likely to be female, young, and have a long duration of mask-wearing per day. Seborrheic dermatitis patients who experienced aggravation or de novo development (132 out of 184) were younger, and they more frequently involved the chin and jaw in addition to the nasolabial folds and both cheeks. Contact dermatitis patients (132 out of 147) with aggravation or de novo development tended to be female, involve both cheeks, and complain of pruritus. Aggravated or newly developed atopic dermatitis patients (165 out of 224) were more likely to be female, and had a higher baseline investigator global assessment score before mask-wearing.

CONCLUSION

Clinical features and factors related to aggravation were different according to the types of facial dermatoses.

Sleep quality, circadian preferences, and mood among patients with acne vulgaris: a case-control study

PURPOSE

Poor sleep and mood may be predisposing factors for acne. We aimed to investigate the associations between acne and sleep quality, circadian preferences, and mood.

METHODS

This case-control study recruited patients with acne and age- and sex-matched healthy controls. We used the Investigator's Global Assessment to evaluate acne severity and various validated questionnaires to measure sleep quality, daytime sleepiness, sleep apnea, circadian preference, and mood symptoms.

RESULTS

A total of 81 patients with acne (age: 21.6 ± 5.0 years, 52% female) and 76 controls were recruited. Compared to controls, patients had a higher score on the Pittsburgh Sleep Quality Index (5.2 ± 2.6 vs. 4.1 ± 2.3, p = 0.008) and State-Trait Anxiety Inventory (State: 44.6 ± 9.7 vs. 40.6 ± 6.6, p = 0.003; Trait: 47.9 ± 8.2 vs. 45.3 ± 6.2, p = 0.03), and a lower score on a reduced version of the Morningness and Eveningness Questionnaire (13.9 ± 2.6 vs. 14.7 ± 2.3, p = 0.05) and Epworth Sleepiness Scale (7.4 ± 3.4 vs. 8.6 ± 3.6, p = 0.04). Acne severity was associated with sleep quality (β = 0.33), eveningness (β = 0.34), depression (β = 0.66), and anxiety (State: β = 1.73; Trait: β = 1.21), even when adjusted for education level and family history of acne.

CONCLUSION

Acne is highly associated with poor sleep and mood. Dermatologists are advised to attend closely to the psychological impact of acne. Improvements in sleep and mood may benefit the treatment of acne.

Sun exposure, a relevant exposome factor in acne patients and how photoprotection can improve outcomes

BACKGROUND

Acne pathophysiology includes a complex interaction among inflammatory mediators, hyperseborrhea, alteration of keratinization and follicular colonization by Propionibacterium acnes.

AIMS

To describe the impact of the exposome on acne and how photoprotection can improve outcomes.

METHODS

A narrative review of the literature was carried out; searches with Google Scholar and Pubmed from January 1992 to November 2022 were performed. The keywords used were "acne," "sunscreens," "photoprotection," "cosmetics," "cosmeceuticals," "pathogenesis," "etiology," "exposome," "sunlight," "stress," "lack of sleep," "diet," "postinflammatory hyperpigmentation," "pollution," "exposome," "ultraviolet radiation," and "visible light."

RESULTS

Environmental factors such as solar radiation, air pollution, tobacco consumption, psychological stress, diverse microorganisms, nutrition, among others, can trigger or worsen acne. Solar radiation can temporarily improve lesions. However, it can induce proinflammatory and profibrotic responses, and produce post-inflammatory hyperpigmentation and/or post-inflammatory erythema. While photoprotection is widely recommended to acne patients, only four relevant studies were found. Sunscreens can significantly improve symptomatology or enhance treatment and can prevent post-inflammatory hyperpigmentation. Furthermore, they can provide camouflage and improve quality of life. Based on acne pathogenesis, optimal sunscreens should have emollient, antioxidant and sebum controlling properties.

CONCLUSIONS

The exposome and solar radiation can trigger or worsen acne. UV light can induce post-inflammatory hyperpigmentation/erythema, and can initiate flares. The use of specifically formulated sunscreens could enhance adherence to topical or systemic therapy, camouflage lesions (tinted sunscreens), decrease inflammation, and reduce the incidence of post-inflammatory hyperpigmentation/erythema.

The Emotional Impact of Maskne in the Era of COVID-19: A Commentary on the Future of a Multi-Modality Approach

Over the past two years, the world has experienced the destructive effects of the SARS-CoV-2 pandemic, better known as COVID-19. The use of surgical face masks was declared necessary by many governments around the world to protect citizens from catching the rapidly spreading virus. Albeit surgical masks contributing to stopping the spread of SARS-CoV-2, many people have reported rashes closely resembling acne on their chins ever since wearing face masks became mandatory. This article studies the acne that results from masks worn to prevent the transmission of the SARS-CoV-2. Acne due to the wearing of masks (“Maskne”) is a new challenge that has affected the population and can decay the mental health of societies and individuals. The exploration of the mental and physical health effects of “Maskne” help us to form treatments that emphasize the association of improving mental health to decrease acne and enhancing quality of life.

Mask Acne in Skin of Color: A Significant Dermatological Condition Amidst the COVID-19 Pandemic

The COVID-19 pandemic has given rise to the need to use personal protective equipment such as masks, among healthcare professionals and the general public. Numerous facial dermatoses linked to the use of masks have been described, from which the term maskne or mask acne has emerged. Although prolonged mask usage has been necessary, and a vast majority of people develop various skin conditions, there is a lack of research on the effects of masks on skin. In this article, we review alterations in biochemical properties of skin associated with mask use in individuals with skin of color and the factors predisposing them to developing acne. Because masks are crucial in preventing the spread of COVID-19, we also elucidate some fundamental strategies such as gentle skin care measures, decreasing the duration of mask wear, and following appropriate protocols for mask re-use, which may prevent mask acne and its long-term effects.

Maskne: The Epidemic within the Pandemic: From Diagnosis to Therapy

Maskne, a newly coined term deriving from the contraction of mask-related acne, is a form of mechanical acne resulting from continuous textile–skin adherence and friction. Prolonged mask use heats up the face environment, thus modifying skin microbiota and sebum production. Although effective prevalence is unknown, since the pandemic began and the prolonged use of masks was extended to the general population, maskne has been a frequent topic of consultation among dermatologists. This term has been successfully introduced into common language, with more than 200,000 hashtags on social media, where it is also possible to find “home remedies” that can worsen this dermatosis. The aim of this paper is to discuss the pathogenesis, address clinicians on the correct differential diagnoses among facial dermatoses, and move towards the correct therapy.

Dermatology: how to manage acne vulgaris

Background

Acne vulgaris is the most common skin disease that can lead to disfigurement and psychological distress. This article aims to provide a narrative updated review on the management of acne vulgaris.

Methods

A PubMed search was performed with Clinical Queries using the key term “acne”. The search strategy included clinical trials, meta-analyses, randomized controlled trials, observational studies and reviews. The search was restricted to articles published in English.

Results

Treatments of acne include proper skin care, topical medications, oral medications and procedural therapies. Topical agents are the first-line treatment for mild-to-moderate acne and can be used as combination therapy for more severe acne. Systemic therapies are usually prescribed for the initial treatment of moderate-to-severe acne as well as for acne that is refractory to topical therapies.

Conclusion

Topical retinoids are the drugs of choice for the treatment and maintenance therapy of patients with mild-to-moderate acne vulgaris. Depending on the severity of the acne, topical retinoids may be used alone or in combination with benzoyl peroxide and topical or oral antibiotics. Oral antibiotics are an important therapy for inflammatory acne unresponsive to topical therapy. Neither topical nor oral antibiotics should be used as monotherapy. Oral contraceptives and/or spironolactone are useful for many women with acne. Oral isotretinoin is the drug of choice for severe, extensive, nodular acne vulgaris but is also often used in moderate cases where scarring is evident, acne-related psychosocial distress is significant or other treatment modalities have failed.

The Future of Functional Clothing for an Improved Skin and Textile Microbiome Relationship

The skin microbiome has become a hot field of research in the last few years. The emergence of next-generation sequencing has given unprecedented insights into the impact and involvement of microbiota in skin conditions. More and more cosmetics contain probiotics or bacteria as an active ingredient, with or without scientific data. This research is also acknowledged by the textile industry. There has been a more holistic approach on how the skin and textile microbiome interacts and how they influence the pH, moisture content and odour generation. To date, most of the ingredients have a broad-spectrum antibacterial action. This manuscript covers the current research and industry developments in the field of skin and textiles. It explores the nature of antimicrobial finishing in textiles which can disrupt the skin microbiome, and the benefits of more natural and microbiome friendly therapies to combat skin conditions, malodour and skin infection.