Wash your hands. Use hand sanitizer. These 2 directives are the first steps recommended by the Centers for Disease Control and Prevention to help prevent the spread of the novel coronavirus disease, COVID-19.1
Specifically, everyone is encouraged to wash their hands often with soap and water “for at least 20 seconds especially after having been in a public place” or after blowing noses, coughing, or sneezing. The second line of personal defense in containing the pandemic is to use a hand sanitizer that contains ≤60% alcohol if soap and water are not available. The hand sanitizer should cover all surfaces of the hands, which should then be rubbed together until they feel dry.1
These simple steps are easy to follow and can empower everyone to both safeguard their health and to ensure the well-being of others. However, for individuals with skin barrier disorders, the constant handwashing and hand sanitizing espoused by healthcare organizations and dictated by common sense can trigger such conditions as eczema and psoriasis.
For insights into the effect of vigilant personal hand hygiene and guidance on how to best maintain these practices while addressing concerns about skin disorders, we spoke with Joel Schlessinger, MD, a board-certified dermatologic surgeon and RealSelf contributor; his practice, Skin Specialists, PC, is located in Omaha, Nebraska.
Dermatology Advisor: To contain the spread of COVID-19, people are washing their hands and using hand sanitizer much more frequently than they may have in the past. Have many of your patients reported worsening of their existing skin conditions because of these measures?
Joel Schlessinger, MD: We are seeing quite a bit of hand dermatitis in our patients. Our clinic has transitioned to telemedicine during the pandemic, so we are seeing a diverse group of patients, and many are affected. The pandemic may be difficult for people who are depressed from the events of the past several months; this may lead to rashes and irritation from compulsive itching or handwashing.
Also, people have now switched to using significant amounts of Purell® or other hand sanitizers, which has led to an increase in the number of people experiencing hand irritation and dermatitis. Generally, soap and water is a little — although not much — better tolerated.
We are telling our patients and staff to wash, but not compulsively or they won’t be able to wash during the times that are necessary. It is a fine balance, to be honest. My son and I developed a product, FixMySkin® Healing Body Balm, which is 1% hydrocortisone with other ingredients such as shea butter and beeswax in a stick formulation that helps to repair the damaged skin barrier. It can easily be carried in a purse or pocket and helps greatly with challenged skin.
Dermatology Advisor: How many new cases of hand hygiene-related issues have you seen or anticipate seeing?
Dr Schlessinger: We are seeing them to some degree in nearly every patient who is actually taking the precautions seriously.
Dermatology Advisor: What types of skin disorders are most affected by hand hygiene?
Dr Schlessinger: When faced with frequent or excessive handwashing, patients with conditions like psoriasis and eczema, which are characterized by dry, inflamed, cracked skin, struggle the most. Even the gentlest hand soaps strip the skin of moisture, which is already a concern with psoriasis and eczema flare-ups. Patients with children are particularly hard hit as they are “washing for 2” or more. Children require a bit of attention, and infants and toddlers with diapers are a particular challenge to keep clean without the adults needing some significant cleaning of their hands afterward.
Dermatology Advisor: Which practice is safer for patients with skin barrier issues, handwashing or hand sanitizer, and why?
Dr Schlessingger: Not only is handwashing safer for patients with skin barrier issues, it is also more effective. Many hand sanitizers contain large amounts of alcohol that may irritate and dry skin. More hand sanitizer is needed to thoroughly disinfect hands than is typically used, and even when hand sanitizer is applied correctly, handwashing addresses a wider array of germs. Simply put, applying hand sanitizer should never take the place of handwashing if good, nonirritating soap and water are available.
Dermatology Advisor: Can you describe what happens to the skin with frequent handwashing and sanitizing, and how it aggravates or creates skin issues?
Dr Schlessinger: Overwashing breaks the outer layer of skin, which encourages bacteria to get in and moisture to get out. Overwashing leads to reddened, dry hands and in serious cases can create cracks in the skin, increasing the risk for infection.
Dermatology Advisor: How can patients best guard against skin conditions despite frequent handwashing and sanitizing?
Dr Schlessinger: Once you have finished thoroughly washing your hands, follow with a hand cream to restore the skin barrier and repair any damage washing may have caused.
Centers for Disease Control and Prevention (CDC). How to protect yourself. www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html. Accessed March 24, 2020.