PHOTO: iStock
(CNN) —  

For Nancy, a nurse in an intensive care unit in New Jersey, her skin care woes started with breakouts on her face and soreness behind the ears. As the weeks ticked on, those same skin irritations began to escalate among her co-workers as their shifts got longer to meet the growing demand for hospital support during the coronavirus pandemic. “Our skin does get torn up and bruised when wearing these masks for 12 to 14 hours per shift,” she tells CNN Underscored.

Gwen, another nurse in New Jersey, has been dealing with acne breakouts, irritation and redness as well. “These masks make it very difficult to breathe, and there is no air circulation,” she says. “I see irritation right where the mask molds against my face, which I like to call my ‘hero wounds.’”

PHOTO: iStock

The hospital workers we spoke with have gotten innovative with ways to ease the physical pain they experience while wearing face masks. They will sport headbands with buttons or throw their hair into space buns to protect their ears from the elastic bands of masks, although it doesn’t always help. “I wear my hair in all sorts of styles so that the mask isn’t as tight behind my ears and along my face, although they are (still) very tight. Some days I don’t have the ability to shift it around, so these wounds are just inevitable,” adds Gwen.

Nurses and doctors aren’t the only hospital staff experiencing job-related skin issues. Susan, a physical therapist in an acute care hospital and at one of the Covid-19 field medical stations in New Jersey, works closely with doctors, nurses, and respiratory and occupational therapists to help Covid-19-positive patients improve their mobility and function.

“Prior to Covid-19, if we wore masks, it would typically be for five to 30 minutes at a time, not a full shift,” she says. “My skin has started to break out along areas where the masks put extra pressure: under my chin and beneath my eyes.”

PHOTO: iStock

Once we learned about the skin care problems hospital staff are facing, coupled with the Centers for Disease Control and Prevention’s recommendation that everyone wear a protective face covering in public, we reached out to the skin experts, including dermatologists, to break down everything you need to know about skin care and face masks during the coronavirus era.

From dealing with “maskne,” to must-have skin care ingredients to incorporate into your routine, to what materials to avoid when purchasing or making your face masks, we’ve considered every question.

What is maskne?

Health care workers need their masks to be tight-fitting for best efficacy, but the trade-off is that the masks can cause abrasions, cuts, redness, acne, irritation and post-inflammatory hyperpigmentation, explains New York dermatologist Dr. Hadley King.

According to King, we need to make sure our masks are not tighter than necessary and that the mask is smooth and not abrasive when touching our skin. “If you notice this kind of irritation after removing the mask, wash the area with water and a gentle cleanser and apply an ointment to help the skin heal,” she adds.

Aquaphor Healing Ointment ($13.79; target.com)

Aquaphor Healing Ointment
Aquaphor Healing Ointment

CeraVe Healing Ointment ($17.18, originally $19.99; amazon.com)

CeraVe Healing Ointment
CeraVe Healing Ointment

“Lubricate the skin with occlusive ointments like Aquaphor Healing Ointment and CeraVe Healing Ointment to create a barrier and help the skin heal,” says King.

Dynarex Hydrocolloid Dressing ($14.28; amazon.com)

Dynarex Hydrocolloid Dressing
Dynarex Hydrocolloid Dressing

“Thin hydrocolloid bandages can also be placed in high-impact areas like the nose and cheeks to relieve some pressure,” she says.

Summer maskne

Summer means increased temperatures and humidity, which could affect both our comfort while wearing a mask and the health of our skin, according to the professionals we spoke with.

There are two main ways face masks can damage the skin, according to Dr. Joshua Zeichner, director of cosmetic and clinical research in dermatology at Mount Sinai Hospital in New York.

“First, direct friction can lead to skin barrier disruption, irritation and inflammation,” he says. “Second, masks can trap oil, dirt and sweat on the skin, leading to flares of conditions like acne, eczema and rosacea.”

King agrees, saying, “Skin irritations from rubbing, friction and pressure are likely to be exacerbated by sweat, which can make the skin more vulnerable to irritation similar to chafing in the summer.”

PHOTO: iStock

Dr. Harold Lancer, dermatologist and founder of Lancer Skincare, anticipates similar issues will crop up in the coming months. “Besides irritations and reactions to mask materials, the heat factor will cause a moisture change in the skin that is covered by the mask,” he says. “This can lead to problems in pore structure and congestion, blemishes and excessive oil retention, which may lead to yeast overgrowth and a worsening of rosacea.”

And if you have acne-prone skin, be prepared to deal with pimples this summer. “The biggest issue we are likely going to see is acne breakouts under your face mask, as oil and sweat are trapped in the skin,” explains Zeichner. “We may start to see heat rash-like reactions because the masks occlude the skin and prevent the release of heat.”

He also notes that eczema and rosacea could flare up when masks trap sweat, dirt and oil on the skin.

How to prevent maskne

First things first: Continue your morning and evening skin care routines, and be sure to wash your face before and after wearing a mask.

“Polishing, cleansing and nourishing the skin daily will ensure skin barrier maintenance and repair,” Lancer says. “Normal cleansing is important at this time, as it removes natural debris, but the antibacterial component creates an added barrier of safety. Make sure to have a post-cleansing thorough rinse.”

Neutrogena Ultra Gentle Foaming Cleanser ($8.29; target.com)

Neutrogena Ultra Gentle Foaming Cleanser
Neutrogena Ultra Gentle Foaming Cleanser

You’ll want to make sure to use facial cleansers that are gentle on the skin. “Use products that will effectively remove dirt and oil without disrupting the skin barrier,” says Zeichner. “The Neutrogena Ultra Gentle Foaming Cleanser uses hydrophobically modified polymer technology to cleanse the skin without compromising the skin barrier.”

CeraVe Salicylic Acid Cleanser ($9.89; target.com)

CeraVe Salicylic Acid Cleanser
CeraVe Salicylic Acid Cleanser

If you have oily and acne-prone skin, use a face wash with salicylic acid twice a day to keep sebum in check and prevent pimples.

“Salicylic acid is an excellent comedolytic, or pore-clearing, ingredient because it exfoliates the stratum corneum (the surface of the skin) and penetrates pores to remove sebum,” explains King. “This helps to prevent pores from becoming clogged and can help remove clogs that have already formed.”

Acne Free Blackhead Removing Scrub ($8.55; amazon.com)

Acne Free Blackhead Removing Scrub
Acne Free Blackhead Removing Scrub

She also suggests using this scrub, which contains 2% salicylic acid and has charcoal to absorb oil, every few days.

Next up, pat on a lightweight moisturizer to hydrate your skin. All three doctors suggest that we look for products with hyaluronic acid for this step. “Heat, perspiration and friction from the mask rubbing skin will potentially cause an irritant dermatitis and perhaps a facial yeast overgrowth,” Lancer says, adding that the soothing, anti-inflammatory properties of hyaluronic acid “moisturize the skin and fight these issues.”

Paula’s Choice Hyaluronic Acid Booster ($36; amazon.com and nordstrom.com)

Paula
Paula's Choice Hyaluronic Acid Booster

We’re fans of this moisturizer because it has emollients that help to plump up the skin. Plus, it contains adenosine, panthenol and glycerin, which together are known to help repair the skin, heal inflammation and boost collagen production.

Cosmedica Skincare Hyaluronic Acid Serum (starting at $10.95, originally $19.57; amazon.com)

Cosmedica Skincare Hyaluronic Acid Serum
Cosmedica Skincare Hyaluronic Acid Serum

This Amazon cult-favorite hyaluronic acid serum has more than 14,000 reviews, with reviewers noting how quickly their skin felt plumper and more hydrated after use.

Yes to Tomatoes Blemish Clearing Facial Wipes, 30-Count ($4.29; target.com)

Yes to Tomatoes Blemish Clearing Facial Wipes, 30-Count
Yes to Tomatoes Blemish Clearing Facial Wipes, 30-Count

For those with acne-prone and oily skin who want a super simple routine, Lancer recommends blemish control wipes to “keep excess oil under control, and they don’t require significant time.”

Clean & Clear Advantage Spot Treatment ($6.49; target.com)

Clean & Clear Advantage Spot Treatment
Clean & Clear Advantage Spot Treatment

When you have a pesky pimple popping up, try Zeichner’s recommendation: Clean & Clear Advantage Spot Treatment.

“You can apply it to the lower face after cleansing and moisturizing to keep the pores clear,” he says. “It uses a specialized formula to minimize potential skin irritation.”

Hero Cosmetics Maskne Bundle ($23; herocosmetics.com)

Hero Cosmetics Maskne Bundle
Hero Cosmetics Maskne Bundle

Hero Cosmetics has created a maskne-specific bundle as well, complete with two different pimple patches and a balm to help fade and heal post-blemish spots.

Maskne treatment

Generally, both King and Zeichner suggest that we should spot-treat inflamed areas of our face with an over-the-counter anti-inflammatory cream. “Hydrocortisone 1% cream acts as a fire extinguisher to put out skin inflammation,” Zeichner says.

You can also dab on good old-fashioned petroleum jelly.

If you’re a health care worker on the front lines in the fight against coronavirus, you can fill out a form at Donate Beauty, an organization co-founded by four beauty editors who want to distribute beauty supplies to vetted hospital staff.

Can I wear makeup while wearing a face mask?

All three dermatologists advise that we skip wearing makeup under our masks. However, if you want to wear color cosmetics while sporting a face mask, you should adapt your beauty routine to the new norm. Try to keep your makeup to the bare minimum to allow your skin to breathe, especially when off duty. Remember: If you plan to apply any product under the mask area, then you should avoid comedogenic products or your skin may become congested with blackheads.

Kosas Tinted Face Oil Foundation ($42; sephora.com)

Kosas Tinted Face Oil Foundation
Kosas Tinted Face Oil Foundation

Instead, opt for a lightweight base with hydrating ingredients, like this tinted face oil from Kosas. It’s a clean beauty product that contains jojoba seed, avocado and raspberry seed oils to soothe, hydrate and tone your complexion.

Sigma Beauty SigMagic Brushampoo Liquid ($19; amazon.com and dermstore.com)

Sigma Beauty SigMagic Brushampoo Liquid
Sigma Beauty SigMagic Brushampoo Liquid

And don’t forget to take that extra step and wash your beauty tools with a brush cleanser to prevent breakouts from popping up on your face and for peace of mind. This liquid cleanser is antimicrobial to keep germs from colonizing your brushes.

Beautyblender Blendercleanser Solid ($16; sephora.com)

Beautyblender Blendercleanser Solid
Beautyblender Blendercleanser Solid

If you prefer solid brush cleansers, reach for this one, which comes with a grid to rub your tools on to help remove pesky cosmetic stains.

Best face mask for acne

“Look for standard materials and masks that are generally used for surgery or procedural medicine,” advises Lancer. “If you’re making your own mask, use simple 100% cotton fabric to construct it. The more synthetic a material is, the more heat retention occurs on the skin that is covered by the mask. This will likely lead to irritation, so make sure to avoid those.”

If you can’t get your hands on a mask or would rather make your own, then King proposes that you double up 600-thread-count pillowcases or flannel pajamas “that provide up to 60% filtration.”

“If you can see light through the fabric, that’s probably not as safe as something you can’t see light through,” King says. “The thicker, the denser the material, the more likely it’s going to filter better. But if you choose a material that’s too thick, it becomes difficult to breathe.”

And don’t forget to wash your cotton mask. The CDC guidelines say throwing it in the washing machine will get it clean. You can see exactly how to make your own face mask here, and check out 100% cotton options below.

BestMaskBoutique Fabric Face Mask (starting at $5.99; etsy.com)

BestMaskBoutique Fabric Face Mask
BestMaskBoutique Fabric Face Mask

With more than 100,000 sales, these 100% cotton masks are a favorite and available in basically every color of the rainbow.

Kishubaby 100% Organic Cotton Muslin Face Mask With Pocket Filter ($16; etsy.com)

Kishubaby 100% Organic Cotton Muslin Face Mask With Pocket Filter
Kishubaby 100% Organic Cotton Muslin Face Mask With Pocket Filter

Available in a wide variety of rather lovely colors like lavender, rust, olive and more, these are constructed with six layers of fabric and come with a pocket where you can insert a filter.

LuckyDuckyUS 3-Layered 100% Cotton Face Mask (starting at $13; etsy.com)

LuckyDuckyUS 3-Layered 100% Cotton Face Mask
LuckyDuckyUS 3-Layered 100% Cotton Face Mask

Lots of different patterns are available for this one, including red gingham and hot pink plaid. They also come with a pocket for a filter.

Note: The prices above reflect the retailers’ listed prices at the time of publication.