Wearing Mask 8 Hours Per Day Linked to Worsened Acne and Rosacea

white face mask on red background
Still life of a face mask on red background
Mask-related rosacea and acne (“maskne”) in untreated patients during lockdown was evaluated.

Mask wearing has become normalized across the globe during the COVID-19 pandemic, and facial masks may worsen acne (“maskne”) and rosacea in some people, study in Dermatologic Therapy suggests.

In this prospective, observational study, researchers examined teledermatologic evaluations conducted in Italy for 30 patients with acne (median age, 34 years) and 36 patients with rosacea (median age, 48 years).

The Global Acne Grading Scale (GAGS) and Dermatology Life Quality Index (DLQI) were used to stage acne. Mask-covered areas were compared with non-mask-covered areas. Rosacea was staged using the Clinician’s Erythema Assessment (CEA), Global Flushing Severity Score (GFSS), Investigator Global Assessment (IGA), Patient Self-Assessment (PSA), and DLQI.

Overall, patients with acne and rosacea reported wearing a mask for a median time of 8 hours per day.

The median DLQI scores for patients with acne significantly worsened from baseline to 6 weeks after quarantine (8 vs 11, respectively; P <.0001). Patients with acne also had worsened median GAGS scores after 6 weeks for the left cheek (2 vs 4; P <.0001); right cheek (2 vs 4; P <.0001); nose (1 vs 2; P <.0001); chin (1 vs 2; P <.0001); a combination of cheeks, nose, and chin (5 vs 12; P <.0001); and global GAGS (9.5 vs 17.5; P <.0001).

In the rosacea population, the researchers also observed significantly worsened median DLQI (7 vs 10; P <.0001), CEA (2 vs 3; P <.0001), GFSS (2.5 vs 4.5; P <.0001), IGA (2 vs 3; P <.0001), and PSA (2 vs 3; P <.0001) scores after 6 weeks of quarantine with mask wearing. These significant findings were similar in 2 patient subcategories of papulopustular rosacea and erythematotelangiectatic rosacea.

Limitations of this study included the small sample size as well as the reliance on remote evaluations, which limited the ability to measure changes in the facial microbiome.

The investigators concluded that additional studies are needed “to evaluate the best therapeutic approaches and counteract the pro-inflammatory effect of masks.”


Damiani G, Gironi LC, Grada A, et al. COVID-19 related masks increase severity of both acne (maskne) and rosacea (mask rosacea): multi-center, real-life, telemedical, and observational prospective study. Dermatol Ther. Published online February 19, 2021. doi:10.1111/dth.14848