Irritation Behind the Ears from Face Masks During COVID-19

Irritation behind the ears from wearing face masks with ear loops is inevitable during the COVID-19 Pandemic. Doctors, nurses, dentists, dental hygienists and others that have worked for years wearing face masks know about this problem. Now everyone is getting a chance to experience it and the problem won’t go away until the COVID-19 Pandemic is over. You need to understand why this happens, what some of the unusual causes are and how to prevent the skin from developing a fissure or large sore.

Why ear loop masks cause pain behind the ears

The elastic creates pressure and that alone can cause pain. But, the fold behind the ear is home to some more unique problems that put it at high risk for problems from the ear loops that secure your face mask.

The fold behind the ear is prone to seborrheic dermatitis. Seborrhea can reside quietly in this fold until the fold is injured or traumatized. The seborrhea creates inflammation and weakness of the skin, making it fragile and prone to breakdown.

If you have a history of sensitivity, soreness and crust in the fold behind your ear, you may have seborrhea. Treat it by washing the area with a dandruff shampoo. Gently remove any crust with a wash cloth in the shower. Apply non-prescription clotrimazole cream to help the dermatitis clear. If that does not help heal the skin doctors sometimes use a little non-prescription 1% hydrocortisone for a few days to speed resolution of the dermatitis. If the skin does not heal in a few weeks it’s time to ask for help from you physician.

Granuloma fissuratum is a sore that classically develops behind the ear due to the mechanical trauma and pressure from the earpiece of your glasses or hearing aid. We can now add face mask ear loops to the causes. Granuloma fissuratum is the presence of a stubborn sore that heaps up in the crease behind the ear and has a tender split or fissure in the middle. Treatment involves avoiding the trauma, which allows the skin to heal. Granuloma fissuratum is also called acanthoma fissuratum

Chondrodermatitis nodularis helicis is another frustrating non-healing sore that happens on the ear secondary to mechanical pressure. It usually manifests as a sore on the top of the ear but can happen anywhere on the cartilaginous ear. It starts because the underlying cartledge festers up and out of the overlying skin. Again, the process starts from trauma such as pressure from sleeping on the ear. It is a frustrating problem to fix and it’s best to avoid it by limiting trauma to the ear.

Another cause of inflammation and discomfort in the fold behind the ear due to ear loops is elastic contact allergy. Yep, you can be allergic to the chemicals that make up elastic. The fold behind the ear is exposed to elastic for long periods of time when wearing face masks with ear loops. The skin is thin and elastic chemicals will enter the skin putting you at risk for becoming allergic. Washing elastic, bleaching it and drying it in the drier increases the amount of elastic chemicals that leach out of elastic due to laundry care. There will be some itching involved in the allergic reaction. Treatment will necessitate avoidance of elastic exposure. Once allergic to elastic, all elastic will potentially cause a rash over time. It’s best to limit elastic exposure to only what is necessary.

How to avoid irritation and pain behind the ears from face mask ear loops

There are some cleaver ways to loop the elastic of ear loops around buttons and buns that I found on Nurses.org If you can't avoid elastic ear loop masks I suggest you take a look at these ingenious solutions. Once again, nurses to the rescue!

My preferred way to avoid ear irritation is to wear a face mask with ties that tie behind your head. This is what I have done for years in my dermatology practice. I couldn’t tolerate the ear loops and had cloth masks made for myself by the seamstresses that made our cloth exam gowns. I wore these cloth surgical masks for over 20 years at work and now wear them when I am out in public during the COVID-19 pandemic. I could have never predicted this!

How to launder your fabric face masks to avoid skin irritation

I recommend washing fabric face masks in hypoallergenic laundry soap, rinsing them well and avoiding the use of fabric softener. This is because detergent residue and fabric care product fragrances are also potential allergens. If your mask is entirely cloth you may be able to bleach it. You may also be able to machine dry it.

If you are wearing a mask with elastic, avoid bleaching your mask and don't put it in the drier. Hang dry your masks to help prevent the elastic from breaking down quickly.

I think we all suspect that face masks are the new normal for the foreseeable future. Getting the perfect mask made of material that your skin tolerates, not introducing or releasing allergens during the laundering of your mask, taking good care of the skin behind your ears and on your face that come into contact with your mask and minimizing pressure and trauma from tight fitting areas will be important to wearing masks with comfort and ease.

Dermatologist's information on skin problems due to protective wear during the COVID Pandemic

Ear loop irritation is just one of the new dermatologic misadventures with our new Pandemic lifestyle. I've written about others. Click here for more information on:

• Facial irritation due to allergic reactions to face masks,
• My advice for how to prevent facial irritation from face masks,
• Hand care to prevent dryness during a pandemic (I wrote this article back in 2009 during the Swine Flu. I have updated it and it's even more appropriate today during the COVID-19 Pandemic) and,
• nail fungal infections due to wearing gloves during the Pandemic.

It’s a brave new world of skin problems that we face as we navigate life during the COVID Pandemic. How do I protect myself and my own skin?

Dermatologist's COVID Pandemic Survival Kit

Foaming Zinc Cleanser to control seborrhea behind the ears. Many people are finding that this common scalp skin problem is flaring up during the shelter in place.

Survival Kit for Busy Hands - everything you need to protect and treat your hand skin during this time of avid hand washing.

Complete Facial Skin Care Kit dermatologist-recommended facial skin care designed to keep face skin healthy and help prevent face mask irritation.