Thanks to COVID-19, we’ve become intimately familiar with certain quirks of quarantine life: Vivid, recurring dreams have permeated our sleep. Virtual happy hours have become just as exhausting as IRL ones. And skin complaints have seemingly surged, even though many of us have hardly left our houses.
“People definitely are having issues with acne,” says Anthony Rossi, a dermatologist at Memorial Sloan Kettering Cancer Center in New York. “Even myself, I don’t usually break out, but I’m breaking out in little pimples.”
Call it Quarantine Skin. Life-saving social distancing measures have had unintended effects on the way we work, rest and navigate day-to-day life. Experts say our new reality — and the disruption of old routines — may be to blame for the reemergence of rosacea, eczema, acne, atopic dermatitis and other skin conditions.
Stress out, break out
One of the primary culprits of Quarantine Skin is stress. There’s just so much uncertainty related to the virus itself, as well as jobs, education, travel, leisure and even haircuts. Dealing with multitudes of unknowns compounds the stress of whatever was already keeping us up at night.
The well-established link between stress and crappy skin has tons of scientific and anecdotal support. “Stress hormones have been shown to stimulate oil glands, pushing them into overdrive and leading to acne breakouts,” says Joshua Zeichner, the director of cosmetic and clinical research in dermatology at New York’s Mount Sinai Hospital. Stress can trigger eczema and rosacea flare-ups too.
In a 2015 study exploring stress and psoriasis, researchers found that half of participants first experienced psoriasis during a stressful life event. In a 2018 study of medical students, those who self-reported the highest levels of stress were more likely than their less-stressed counterparts to have oily, waxy patches or flakes on their scalps, as well as rashes, warts, pimples and itchy skin.
For Jac M., a 23-year-old from Charlotte, North Carolina, stress has always played a major role in outbreaks of eczema, cysts and acne. Bouts of depression and hormone swings during their cycle usually precede a flare-up of some sort, they say. As the pandemic took hold in the US, Jac lost their job and became unable to attend school. Around the same time, they began using the skincare line Proactiv. They believe the new products, combined with stress, gave way to patches of eczema on their eyelids, cystic acne, and blistering that turned into scabs that wouldn’t go away. “I look like a garden gnome,” Jac says. (They’ve since stopped using Proactiv and some of the scabbing has healed.)
Because they realize stress is a trigger for their breakouts, Jac has learned to accept inevitable flare-ups — especially during the pandemic. “I’ve had worse things other than my skin happen to me from the stress,” they say, “but the skin is the ongoing thing because you’re stuck with yourself. It doesn’t help that the stress is making me want to pick at my face or squeeze it or try any little thing to make it presentable, but it’s like, Where are you going, man?”
Bodies run better on routines
For many people, stay-at-home orders have completely overturned everyday life: no morning commute, gym sessions or dinners with friends. When we lose our usual routines, or let healthy habits fall by the wayside (a completely normal thing to do), our bodies respond. “If you’re not doing your same exercise routine and your same diet, and [not] moving, [plus] this idea that if you’re more snacking at home and leading a sedentary lifestyle, it does change things,” Rossi says. “The highly processed foods are not great for your skin. The refined sugars, the refined carbohydrates, that’s usually an offender for people’s skin to break out.”
Although she’s dealt with acne for most of her life, 25-year-old Astrid Morales noticed that her breakouts have become more intense since the pandemic began. “I was really frustrated because I was looking at myself in the mirror,” she says. “I started breaking out like never before. My whole skin area is so full of little whiteheads and red bumps all the way down to my neck.”
As a home health aid for elderly patients in El Paso, Texas, Morales is still working. But in her downtime, she’s working out less and eating more junk food, which she blames for her Quarantine Skin. “I get home and I order something to eat and just watch TV,” she says.
For many people, sleeping patterns have also changed during quarantine. “Beauty sleep is a real thing,” Zeichner says. “When we sleep, cortisol levels decrease. We also know that in the evening, skin cell turnover increases and skin better repairs itself from damage during the day.”
On the flip side, both a lack of sleep and low-quality sleep are associated with bodily inflammation. Studies have found that sleep loss exacerbates inflammatory skin disorders such as psoriasis and acne. Additionally, researchers behind a 2019 sleep-acne study posit that the psychological stress of having severe acne might also contribute to disrupted sleep. In other words, there’s a chicken-egg situation to untangle.
Hygiene might be another factor in Quarantine Skin. If you’re skipping your morning shower once in a while because, hey, your cleanliness standards are lower for virtual interactions, you may not be washing your face as frequently as you used to. And if you’re wearing makeup less often than you did pre-coronavirus and your skin has somehow gotten worse, take stock of your nighttime skincare regimen: Without any makeup to remove, do you still wash your face before bed?
“Even though we’re telling people not to touch their face, if they’re just in the house, they’re less stringent,” Rossi says. “The idea that you’re picking or just touching your face and you’re not going through the whole cleansing routine” could help explain new blemishes.
The wrong kind of face mask
Before the coronavirus, the majority of us went about our days with uncovered faces (or had the option to). Now we’re all supposed to wear nonsurgical masks when we go out in public, per the Centers for Disease Control and Prevention. Since experts now believe that widespread mask usage substantially reduces disease transmission, masking up is in all of our interests.
But wrapping half your face in layers of fabric isn’t especially comfortable or good for your skin. “Friction from rubbing of the mask against the face disrupts the outer skin layer, leading to inflammation,” Zeichner says. “The masks also trap humidity, creating an environment that causes a buildup of oil and dirt on the skin and allows microorganisms like fungi and bacteria to grow.”
The ill effects of masks are pronounced for frontline workers, especially those in healthcare, who don masks for more than just errands and dog walks. In a survey of medical professionals in Wuhan, China, where the coronavirus first emerged, nearly 75 percent reported skin dryness, papules and skin maceration (soggy, whitish skin caused by excess moisture) on their cheeks and nasal bridges as a result of wearing personal protective equipment.
To prevent mask-induced breakouts, Rossi says to continue your regular skincare routine, but with gentle cleansers. You may need to exfoliate more too. As the weather warms, try to keep the area covered by the mask clean and dry as best you can. Of course, this means regularly washing your mask too. (Fragrance-free detergent is best, especially if you have sensitive skin.)
While our world has fundamentally changed, we should remain committed to the routines we can control, skincare being one, Rossi says. “We’re very routine-based, and the idea that you’re thrown off is really hitting everyone in some way shape or form,” he says. “It’s important that people regain that sense of routine even if they are at home: You wake up, you wash your face, you get ready for the day.”