Managing hand dermatitis while maintaining adequate hand hygiene during the COVID-19 pandemic.

The current COVID-19 pandemic has considerably increased the frequency of handwashing as well as the use of gloves and hand sanitizers. One of the unintended consequences of these good practices is an upsurge in the incidence of hand dermatitis we are seeing as dermatologists.

Hand dermatitis or hand eczema is a non-communicable inflammation of the hands characterized by itch, redness, scale, weeping, blisters and/or fissuring. Hand dermatitis can be due to an allergy to one of the constituents of a product (allergic contact dermatitis) or prolonged exposure to chemical or physical irritants we are exposed to (irritant contact dermatitis). With prolonged exposure, substances that would not otherwise cause any damage to the skin, impair the skin’s integrity resulting in dermatitis.  Irritant contact dermatitis that develops in children whose nappies are left on for prolonged time is a good example.

Frequent washing of hands with soaps and detergents, use of alcohol-based sanitizers and prolonged wearing of plastic or rubber gloves predisposes to hand dermatitis. The trapping of moisture on the surface of the skin increases permeability, chemical exposure and the risk of irritation.

Hand dermatitis has been shown to significantly reduce hand hygiene compliance amongst workers who are compelled to use hand hygiene products. The most common reason for the lack of compliance is the repeated and deleterious effects of using these products. Non-compliance with hand hygiene protocols by workers who provide essential services during this concerted effort to control the pandemic would be undesirable. It is important to disseminate information on the current best practices to manage hand dermatitis in those who are affected or susceptible to maintain high levels of hand hygiene compliance during this time and in the future.

Alcohol-based hand sanitizers recommended by the World Health Organization (WHO) contain glycerin as a moisturizer to protect the skin against dryness and irritant dermatitis. In a small proportion of people who regularly use hand sanitizers, the concentrations of glycerin as recommended by WHO, are insufficient to prevent irritant hand dermatitis. Supplementary moisturizing of the skin is required after use of sanitizers in those who are susceptible or develop hand dermatitis. This is to prevent worsening of the condition and resultant non-compliance with recommended hand hygiene protocols.

Recommendations for those who are susceptible or develop hand dermatitis are summarized below:

·      Most importantly, do not reduce the frequency and duration of hand hygiene protocols that are currently recommended by the Department of Health.

·      Maintain the integrity of skin by applying a moisturizer after sanitizing while ensuring that the surface of moisturizer container is clean by only touching it after sanitizing every time.

·      Do not use unsanitized hands to collect the moisturizer from the container.

·      Apply protective barrier cream before wearing gloves if you fall into the category of people that has to wear gloves as per the current recommendations by the Department of Health. Amongst others, these barrier creams typically contain zinc oxide, talc, silicones, aluminum chlorohydrate or kaolin.

·      Allow your hands to dry and apply a moisturizer between changes of gloves.

·      Apply alcohol-based sanitizer to gloves between changes if you fall in the category people that has to wear gloves as per current recommendations by the Department of Health. Remember, alcohol-based sanitizers may degrade some types of gloves.

·      In severe cases, contact your doctor for advice on appropriate corticosteroid cream

In intractable and severe cases, alcohol free sanitizers are an alternative.

Despite these minor problems that may be associated with the upsurge in hand hygiene, do not lose sight of the bigger picture – good hand hygiene will save lives even if it irritates.

Prof Rannakoe J Lehloenya