Exploring the Effects of Masks on Skin Physiology

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As we adapt to the post-COVID-19 environment, the habitual use of medical masks has become integral for disease prevention.¹ However, this practice has implications for individuals with sensitive skin (SS), which is increasingly recognized in dermatology due to its association with heightened reactivity to environmental stimuli and barrier dysfunction.² Recent research highlights that approximately 39% of the population in major Chinese cities reports mild to severe SS, a figure that has likely risen with the increase in mask-wearing during the pandemic.³

For those with sensitive skin, the compromised skin barrier is manifested by increased transepidermal water loss (TEWL) and sensitivity, which can exacerbate inflammation and increase susceptibility to pathogens.⁴ Researchers behind a recent study stated that the environment created by masks may disrupt the skin’s natural physiology, leading to issues such as erythema and irritation.⁵ Furthermore, the microbiome’s role in maintaining skin health is critical, and the use of masks has been shown to alter its diversity, potentially worsening existing skin conditions.⁶

Study Objectives and Methodology

The study aimed to investigate the effects of mask-wearing on skin barrier function and microbiome composition among women with sensitive skin. Additionally, researchers assessed whether the application of a clinically validated moisturizer before mask use can mitigate adverse effects and support barrier repair.

A cohort of 30 women with self-reported sensitive skin participated in the study, screened via the lactic acid sting test (LAST). Baseline skin parameters, including TEWL, erythema index, stratum corneum hydration (SCH), pH, and temperature, were measured in both masked and unmasked areas of the face before and after wearing a mask for 3 hours. Microbiome samples were collected pre- and post-masking for 16S rRNA sequencing analysis to evaluate microbial diversity.

Results 

Researchers stated the results demonstrated significant alterations in skin physiology after 3 hours of mask-wearing. Notably, they reported increased TEWL, indicating a disrupted barrier, while SCH showed a significant rise, suggesting changes in hydration levels within the stratum corneum. The study stated pH levels decreased, which may reflect changes in skin microenvironment due to occlusion. Furthermore, the physiological impact extended beyond the masked areas, affecting adjacent unmasked skin, albeit to a lesser degree.

Microbiome analysis revealed a notable decrease in bacterial diversity following mask usage. Specifically, researchers found a significant reduction in Bacteroidota, alongside shifts in the abundance of genera such as Cutibacterium and Streptococcus. These alterations underscore the potential for mask-wearing to induce dysbiosis, particularly in individuals already struggling with sensitive skin.

Impact of Moisturizer Application 

Crucially, researchers found the application of a moisturizer prior to mask-wearing significantly improved skin barrier function. TEWL levels were notably lower in areas where moisturizer was applied compared to control areas. Additionally, hydration levels in the stratum corneum were enhanced on the treated side, leading to reduced erythema. The study stated these findings suggest that proactive skincare interventions can play a vital role in mitigating the adverse effects of prolonged mask use on sensitive skin.

Conclusion

The COVID-19 pandemic transformed mask-wearing from a temporary measure into a daily necessity, particularly for individuals with sensitive skin. This study elucidates the physiological impacts of masking on sensitive skin and highlights the protective benefits of preemptive skincare strategies. For clinicians, researchers stated that understanding these dynamics is crucial in guiding patients toward effective management of their skin health in the context of habitual mask use. By incorporating proactive skincare recommendations, the study suggests that clinicians can significantly improve patient outcomes and enhance quality of life for those with sensitive skin.

References

1. Javid B, Weekes MP, Matheson NJ. Covid-19: should the public wear face masks?. BMJ. 2020;369:m1442. Published 2020 Apr 9. doi:10.1136/bmj.m1442
2. Misery L, Loser K, Ständer S. Sensitive skin. J EurAcad Dermatol Venereol. 2016;30 Suppl 1:2-8. doi:10.1111/jdv.13532
3. Chan MKT, Sayag M, Chavagnac M, et al. Sensitive skin in China: characteristics and burden. J EurAcad Dermatol Venereol. 2021;35(7):e436-e439. doi:10.1111/jdv.17100
4. Bosko CA. Skin barrier insights: From bricks and mortar to molecules and microbes. J Drugs Dermatol. 2019;18(1s):s63-s67.
5. Zhong S, Lai Y, Na J, et al. Mask wearing impacts skin barrier function and microbiome profile in sensitive skin. Sci Rep. 2024;14(1):24209. Published 2024 Oct 16. doi:10.1038/s41598-024-75072-2
6. Zhang J, Jiang P, Zhang Y, et al. Effects of wearing masks during COVID-19 pandemic on the composition and diversity of skin bacteria and fungi in medical workers. Front Microbiol. 2023;14:1274050. Published 2023 Oct 26. doi:10.3389/fmicb.2023.1274050