How to wear a face mask if you have atopic dermatitis

Learn how prolonged face mask use can affect atopic skin and what measures may help reduce irritation.

During the COVID-19 pandemic, prolonged use of face masks was associated with worsening of several pre-existing skin conditions, including acne, psoriasis, rosacea, seborrhoeic dermatitis and atopic dermatitis.

Patients with atopic or particularly sensitive skin may be especially prone to irritation in areas covered by a mask because their skin barrier is already more vulnerable.

During periods when prolonged mask use is required, the aim is to protect the skin as far as possible without compromising the appropriate use of protective equipment.

Why can face masks aggravate atopic skin?

According to our dermatologists specialising in atopic dermatitis, several factors can contribute to irritation or eczema beneath a mask:
friction between the mask and the skin;
humidity generated by breathing;
increased sweating in the covered area;
prolonged occlusion of the skin.

These factors can impair the skin barrier and make areas such as the chin, lips, cheeks and bridge of the nose more prone to irritation.

Wearing a face mask if you have atopic dermatitis

The following measures may help reduce irritation when prolonged face mask use is necessary.

Facial cleansing

People with atopic dermatitis should use gentle cleansers formulated for sensitive or atopic skin. Cleansing oils, creams or mild emulsions that do not strip the skin barrier may be preferable to harsh soaps or strongly foaming cleansers. Fragrance-free products are generally advisable, particularly in patients who are prone to irritation or contact dermatitis. After cleansing, the skin should be dried gently without rubbing.

During the day

A light moisturiser or emollient can help support the skin barrier before the mask is applied. If the face will also be exposed to sunlight, appropriate broad-spectrum sunscreen should still be used. A face mask should not be relied upon as the only form of sun protection. For people with sensitive or atopic skin, the most suitable sunscreen is the one that is well tolerated and does not aggravate their dermatitis. Mineral formulations may be useful for some patients, although they are not necessarily required in every case.

Check the fit of the mask

A mask should fit correctly for its intended purpose, but unnecessary pressure and friction should be avoided where possible. The bridge of the nose, cheeks and areas behind the ears may become particularly irritated. A small amount of a bland barrier ointment, such as petrolatum, can sometimes be applied to friction-prone areas if this does not interfere with the fit or function of the mask. Where appropriate, masks secured behind the head rather than around the ears may help reduce irritation in people who develop eczema in the retroauricular area.

At night

Evening skincare should focus on restoring the skin barrier. Regular use of emollients can help reduce dryness and irritation. If eczema develops or worsens despite these measures, dermatological assessment may be required. Depending on the severity and location of the dermatitis, treatment may include topical anti-inflammatory medicines such as topical corticosteroids or calcineurin inhibitors, including pimecrolimus, when clinically appropriate. Mask use can also contribute to acneiform eruptions in some patients. These should be assessed individually, as treatment depends on whether the lesions represent acne, folliculitis, irritant dermatitis or another condition.

What type of face mask is best if you have atopic dermatitis?

During periods when masks are required for infection prevention, the type of mask should be selected according to the level of protection needed and the setting in which it will be used. Medical or respiratory protective masks may cause more friction or occlusion in some patients with atopic dermatitis, particularly when worn for long periods. Where regulations and the clinical situation allow, choosing a mask with a soft inner surface, appropriate fit and minimal unnecessary friction may improve tolerance.

However, skin comfort should not compromise the level of respiratory protection required for a particular environment. For healthcare professionals or people working in higher-risk settings, the necessary protective equipment should be maintained even if it aggravates the skin. In these cases, preventive skincare and dermatological treatment may help improve tolerance.

We invite you to share this article on how to wear a face mask if you have atopic dermatitis with family and friends who may find it useful.