Skin Conditions in Mask-induced Acne, Acne Vulgaris, and Non-acne Patients with Chronic Mask Usage: A Cross-sectional Comparative Study

Abstract

Background: Chronic skin occlusion during the COVID-19 pandemic has resulted in changes in skin moisture and sebum composition, disrupting the skin’s barrier function and leading to an imbalance in skin microflora. This can aggravate acne or lead to the development of new acne lesions, commonly referred to as 'Maskne.' Objectives: To investigate differences in skin parameters and microflora among individuals with Maskne, acne vulgaris, and those without acne. Methods: This study involved three groups, each comprising 33 participants. Skin parameters, such as temperature, pH, microbial flora (assessed by bacterial culture), and pore size (measured through video dermoscopy), were evaluated. Results: Of the 99 participants, 83% were female and 17% were male, resulting in a sex ratio (F) of 4.8:1. Among the participants, 78% used surgical masks, 20% used N95 masks, and 2% used cloth masks. The prevalence of Maskne and acne was higher in females (34% and 35%, respectively). Maskne showed a higher involvement of the chin (58%) compared to acne vulgaris (36%). Additionally, 46% of the participants had identified risk factors for acne. Maskne patients exhibited significantly lower skin pH, larger cheek skin pore size, and higher cheek temperature compared to acne vulgaris patients. However, there was no significant difference in microbial density between Maskne and acne vulgaris. The study identified one Methicillin-resistant Staphylococcus aureus and five Klebsiella spp. colonies. Furthermore, 29% of participants reported experiencing other mask-related problems. Conclusion: Measurement of cheek skin pore size by dermoscopy can serve as a valuable clinical marker for predicting the development of Maskne.