Q&A: Dr. Pimple Popper on Halloween costume-based skin irritation, inflammation

Halloween costumes for kids, adolescents and adults can be fun and creative, but makeup and masks can often cause irritation that could lead to acne, dermatitis or other skin problems.

Whether someone is doing a full face of skeleton makeup or donning their favorite Wookie mask, there are ways to protect the skin from damage and irritation.

Healio spoke with Sandra Lee, MD, known on social media as the popular Dr. Pimple Popper, about how to best prevent and treat breakouts caused by Halloween irritation.

Healio: How can Halloween makeup or masks affect acne or allergic dermatitis, as well as other skin conditions?

Lee: Halloween makeup and masks both create an opportunity for irritation and an environment that’s conducive to increased levels of acne-causing bacteria.

Typical makeup ingredients like oils, waxes, fragrances, pigments and preservatives are often comedogenic and potentially allergenic. Because Halloween makeup and face paint tends to be thicker and more heavily pigmented, it’s generally more likely to contain occlusive ingredients, which exacerbates acne.

Moreover, people tend to store and reuse their old makeup from years past, when it’s essentially become like a Petri dish of bacteria.

So, not only do we have an increased likelihood of non-inflammatory acne occurring with Halloween makeup, but we also have the ideal conditions for more advanced, inflammatory pimples to form.

Masks can cause similar problems, trapping sweat and sebum that creates a breeding ground for P. acnes. The pressure or chafing can also lead to acne mechanica, where the skin becomes irritated and vulnerable. This is particularly true with firmer plastic masks that can poke or rub against the skin.

Latex masks may be more comfortable, but they can also cause dermatitis in those who have a sensitivity or allergy.

Both makeup and masks can also lead to flare-ups of inflammatory skin conditions like eczema, psoriasis or rosacea.

Healio: What is the best way to prevent these issues from occurring?

Lee: There are several things people can do to minimize their risk of having a reaction to Halloween makeup:

Don’t reuse last year’s makeup: it’s probably teeming with bacteria, and chances are high that any oils in it have gone rancid.

Read the label: look for products that are noncomedogenic, hypoallergenic, and are fragrance and preservative-free. Check the ingredients list for any known allergens.

Perform a patch test: apply a bit of makeup to a small area of skin (like the inside of your wrist) for several hours. If no reaction occurs within about 24-48 hours, it’s probably safe to use on your face.

Start with clean skin: applying occlusive makeup traps any dirt, oil or old makeup underneath, so wash your face first.

Apply moisturizer or primer: this creates a protective barrier between makeup and the skin.

Use clean brushes and sponges: don’t dab dirty tools onto your clean face, or into brand new makeup.

Double (or triple) cleanse: to remove makeup, wash first with an oil-based cleanser, then use makeup remover. Follow up with a pore-clearing beta hydroxy acid product like my SLMD Skincare Salicylic Acid Cleanser.

To protect against mask irritation and maskne, always start with clean skin. Give your face a break and remove the mask periodically — if possible, wash your face more frequently. You can also mist the inside of your mask with an acne-fighting product.

Healio: What can parents do for their young children to ensure their costumes are skin safe?

Lee: Children’s skin is more delicate and sensitive than adults', so parents should make sure that their kids’ costumes and makeup are labeled “child-safe” or “for kids.” You want to avoid any outfits, props or makeup that are giving off strong odors — at least air them out before wearing. Costumes in soft fabrics are ideal, but if that’s not possible, have your child wear a thin layer underneath to prevent irritation from scratchy elements or non-breathable synthetics. Wash any items that you can before putting them on. Check masks for any sharp edges that might poke into skin or eyes.

In terms of makeup, the safest bet is to find a quality brand (preferably made in the U.S.A.) that you’re familiar with and have used yourself without problems. Again, read the label: there are some great websites where you can look up any ingredients that you’re not sure about. Do this even with makeup labeled “for kids,” because cosmetics aren’t closely regulated in this country.

For young children, I recommend avoiding embellishments on the face, like glitter, rhinestones and facial hair, as they can be a choking hazard and the adhesive may damage their delicate skin.

Healio: How can clinicians counsel their patients in regard to safe Halloween costumes and makeup?

Lee: I always tell my patients that to keep skin healthy, consistency is key. If they’re following a healthy skin care regimen then one night wearing heavy makeup or a mask is not going to completely derail their progress. I advise them to follow my Halloween makeup tips, and if they do experience a subsequent breakout, to use a mask like my SLMD Skincare Clear Out, which contains salicylic acid and sulfur. Acne patches like my Spot Check are great, too, because they prevent picking and popping.

For my patients with moderate to severe active acne, rosacea, dermatitis, or autoimmune skin conditions, I generally suggest that they steer clear of irritants like glitter, or anything that requires adhesive (like rhinestones or faux facial hair).

It’s also important to make sure that patients understand the signs of skin sensitivity or allergy. Burning, itching, redness, and swelling are clear indications that a product is causing irritation and they should discontinue use. Performing a patch test is always a good idea, particularly if your skin is sensitive.

Healio: Does eating a lot of candy really affect the skin?

Lee: What we know is that high blood sugar levels lead to increased inflammation, which can impact healthy skin and make skin conditions like acne and rosacea worse.

Sugar in the bloodstream also leads to glycation, which is when a sugar molecule attaches to a protein and makes it stiff. In the skin, this can happen with collagen, leading to a loss of elasticity. Glycation also creates damaging free radicals and inflammation, all of which can initiate premature aging.

But again, everything in moderation. One (or two!) nights of indulging in some candy is not going to have a lasting impact on your skin.

Healio: When should someone contact a dermatologist if their skin is showing effects of costumes or makeup?

Lee: A few pimples or a patch of eczema from Halloween makeup or mask irritation is not something to worry about. Follow your normal skin care routine to treat these issues — again, I love spot treatments for individual pimples. For mild irritation, you can try an over-the-counter hydrocortisone cream, just follow the package directions and make sure you don’t use it for more than 7 days. If your breakout, rash or irritation does not clear up by then, it’s a good idea to contact your dermatologist.