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Maskne, Also Known As Acne Mechanica
I just had a London-based physician contact me about a case of Demodex that they personally acquired. This is something they had not even known existed until they got it. This is not due to a lack of intelligence on their part. This is sadly due to lack of training in our medical schools. I had no training regarding Demodex mites in the United States either. Many of us physicians do not know about Demodex, or the diseases associated with the mite. This physician mentioned that she had been treating a case of maskne in herself prior to the Demodex outbreak. It was one of those statements that made me stop, and read it again as it did not make sense to me. In my opinion maskne is a result of Demodex overgrowth, and here was someone who thought they may have caused the Demodex outbreak from treating Maskne. The lotions she used may have indeed made the Demodex outbreak worse, but the increase of Demodex was originally induced by the mask wearing, and if the mask wearer does not realize this the condition will continue. I am surprised by the lack of training being given to us physicians regarding Demodex mites. With all the research available now around Demodex mites, there should be instruction about these ectoparasites in medical schools. Yet most physicians still do not realize that these mites exist, or that there are a variety of health conditions associated with these mites when they grow out of control in our skin. If a practitioner does not know these mites exist it becomes impossible for them to treat a patient when that individual shows up with a skin disease caused by overgrowth of Demodex mites. To make it even worse, I have had patients tell me that there are practitioners who have told them their symptoms of Demodex are in their head and not real. So, what is this ailment that causes pimples, skin irritation, (and even worse issues as we will see below) and may or may not have itching and sensations of movement on the skin, and what is its relationship to wearing masks, athletic gear or working gear? Let us take a closer look.
Mask Wearing For COVID-19 Has Caused A Condition Commonly Known as Maskne
The word maskne is a combination of the words mask and acne. This is a type of acne that has in the past shown up on individuals who wear masks as part of their work. This is a condition seen a lot nowadays by people wearing masks for protection from the SARS-CoV-2 that causes COVID-19. In the past this condition has been seen in health care workers who wear masks a lot. However, this acne can show up from wearing other types of gear that tightly covers the skin and creates a dark, moist environment. We also see it in athletes wearing athletic gear, and workers who wear hard hats, chin straps, vests with heavy padding, or anything that covers the face, back, chest and shoulders where the mites often exist. The more commonly used medical term for these conditions has been Acne Mechanica, which is inclusive of Maskne also.
I see many people claiming the mask induced acne and skin irritation are attributed to a variety of disease processes other than the true cause or Demodex infestation (and the bacteria/fungi associated with these mites). What I notice is that all the health conditions listed as reasons for Maskne are simply health conditions caused by Demodex when the mites start to grow out of control. I am here to tell you that the reason for Maskne, or Acne Mechanica seen in those who commonly wear masks, athletic gear, or working gear is that these protective implements worn on the body all induce an overgrowth of Demodex mites, which live in hair follicles, and the sebaceous glands of the hair follicles in our skin. The face, the back and the chest have a lot of oily areas as well as hairy areas. Demodex mites like darkness, heat, and oily moist areas. Add masks, athletic gear or work gear that occlude these areas, creating a dark, warm and moist environment and the mites proliferate. If the person is slightly immune compromised for a variety of reasons, or they have high blood sugar, this will add to the growth of these ectoparasites also. Those people who are older, and have oilier skin will also tend to have increased issues with maskne/acne mechanica.
Health Conditions Associated With Maskne
Let's examine some of the conditions noted with Maskne. The health issues that are attributed to Maskne are conditions that are caused by Demodex mites. They include rosacea, acne vulgaris, and perioral dermatitis. However, people can have the Demodex overgrowth spread out from the masked area and the mites can cause eye irritation such as blepharitis, sties, conjunctivitis and even more serious eye disease. Demodex mites are not the only issue, as they don't show up by themselves. Demodex mites have bacteria, and yeast that are found on the outside of their bodies and they also ingest bacteria and probably yeast. These mites live in our skin for about 3 weeks. They have no excretory organs as we do, so during this time all the metabolites and excrement build up inside of them. When they die, their toxins pour out into our skin. In small amounts this is not noticeable as they are quite tiny and our skin deals with it. However, when we provide conditions for them to overgrow such as wearing a mask, we now have larger numbers of them causing skin irritation from microabrasians, mechanical blockage of follicles and sebaceous glands, as well as possible immune system reactions to them during their normal routine. Then additionally, there are also larger numbers dying and releasing toxins. This overgrowth of Demodex is what creates the appearance of maskne/acne mechanica. Think of the pimples as the result of toxins from dead mites.
Treatment of Maskne
People should only wear masks, athletic gear/work gear when they absolutely have to. Some people may even need to change their job if the gear creates a condition that becomes serious and can't be remedied otherwise. If masks are necessary, first washing the mask helps as you remove possible chemicals on the mask. finding a type of fabric that is more breathable is helpful, but if wearing a mask to keep something out such as a virus, using a more breathable mask will decrease the masks protection. If you have reusable masks, they must be cleaned often.
If an individual gets maskne they can use Tea tree essential oil about 30% mixed with 70% fixed oil such as cod liver oil, macadamia oil, or another nut oil, or castor oil. I mention these oils as they are less likely than some other oils to induce growth of the mites according to research and clinical practice. Practitioners often use 50% Tea tree oil mixed with one of these fixed oils to treat individuals in their office, but I would warn you that sending an individual home with that strong of a solution, and their using that high of an amount of Tea tree essential oil repetitively can cause some of them to react to the essential oil. Now don’t confuse an actual reaction to the oil with a reaction from the mites. When we use the Tea tree oil on our skin, we are killing mites. This can cause more die off, and more pimples, possibly more itching and irritation from the toxins released from the mites. This is temporary, but it can confuse people into thinking they now have an increased amount of mites. The more mites a person has, and the more reactive the person is to the mites, the more severe this reaction usually is. So, if an individual reacts 2-3 days after using the Tea tree oil, and it is an increase in pimples, that is just a die off reaction from the toxins in their bodies. It will go away slowly. It extremely annoying, but it will go away. Some people do react to Tea tree oil, and if they are reacting to the mix being too strong, dilute it more. Essential oils used in excess can also cause a skin reaction that is similar to the skin being burnt. Some people may react to the essential oil no matter how dilute it is and they should simply not use it. Additionally, there are other choices of essential oils that a practitioner can try with them.
How strong the essential oil mix should be made and how often it is used will depend on the individual's particular situation. One thing that is important for everyone is that they do not use it on their skin under a mask. Essential oils volatilize off the skin, and if a mask is put over the face after applying essential oil to the face, the individual will end up breathing in heavy doses of the essential oil into their lungs. Therefore, they should apply this remedy at night before bed, or at least during a time when they are not wearing a mask. An additional reason for applying the essential oil mix at night is that the mites come out at night in the dark and it will more readily kill them at this time.
Tea tree shampoo can be used to help decrease the number of mites in the scalp if itching and mite movement begins to be noticed here. Even using the shampoo for ten minutes can be helpful, although left on longer will be more beneficial.
For treatment of maskne/acne athletica in a healthy person, it can be as simple as discontinuing the wearing of the items causing the proliferation of mites and using a little Tea tree essential oil. However, for someone who cannot quit using the mask, or other gear, and for those with an underlying health issue, or if they are exposed to environmental toxins, or have other reasons for the Demodex overgrowth that they may, or may not know about, there may be additional hoops the person needs to jump through before their skin is a happy place once again. It is our place as the practitioner to help them figure out the cause of the continued Demodex overgrowth if simple measures do not bring them back to a steady state of skin health again.
These Mites Live In All of Us, But Can Get Out of Control
The fact is that we all have Demodex mites in our skin. They are a normal inhabitant. However, when they get out of control due to our being immunocompromised, having high glucose levels or from wearing a mask or working/athletic gear, or other reasons, they will cause issues. Some of the issues caused by Demodex that you might not be aware of are as follows:
- Pityriasis folliculorum (Ayres, 1930)
- Rosacea (Ayres and Ayres, 1961; Bonnar et al., 1993; Forton and Seys, 1993),
- Pustular folliculitis (Dong and Duncan, 2006),
- Papulopustular scalp eruptions (Purcell et al., 1986),
- Perioral dermatitis (Hsu et al., 2009)
- Blepharitis (Post and Juhlin, 1963; Divani et al., 2009; Zhao et al., 2012).
- It is also suspected that Demodex infestation may be one of the triggering factors of carcinogenesis in eyelid basal cell carcinomas (Erbagci et al., 2003) and sebaceous adenoma (Dhingra et al., 2009).
- The infestation rate in the immunocompromised population with leuco-cythemia (Damian and Rogers, 2003) or acquired immune deficiency syndrome (AIDS) (Clyti et al., 2005) is remarkably high and pustular eruption or seborrheic dermatitis becomes even more suspicious of demodex in this group of people.
- Small intestinal bacterial overgrowth (SIBO): Research suggests that patients with rosacea (commonly caused by Demodex) are 13 times more likely to have SIBO compared with healthy controls. Treating SIBO may help decrease the Demodex and rosacea in these cases. I have seen Demodex and rosacea both disappear when making sure an individual has proper HCL, digestive enzymes and bile. Getting their digestion in order is important.
- Chalazion or meibomian cyst or eyelid cyst(also called a stye) – basically a clogged gland
- Seborrheic dermatitis (Karincaoglu et al.,2009)
For Non-practitioners Reading This Article
If you have maskne, or any of these conditions listed above, ask your practitioner to consider Demodex as a factor in the disease process. If they don't know what is causing your condition they will use a treatment that will usually not work long-term. If they don’t know anything about Demodex tell them to read up on the literature as there are many research studies now available. It is not their fault they don't know about it as they were quite likely never trained about Demodex mites at all. The research on Demodex is almost all from the last 20 years, with most of the research over the last 10 years. Give them this article on Demodex and if that still does not work, wait for my book to come out and give that to them. I am working on it as fast and furious as I can. It will be here in late spring of 2022.
Send this article to practitioners, friends and family who will benefit from it!