PPE-Related Skin Conditions and Patient Exposure Main Issues for Dermatologists During COVID-19

Skin conditions related to prolonged personal protective equipment (PPE) exposure and a possible increased risk for contracting COVID-19 for dermatology patients are the main issues facing dermatologists during COVID-19, according to an update published in Clinics in Dermatology. 

The study authors wrote that frontline healthcare workers wearing PPE such as masks, goggles, hats, and gloves for long periods have reported clinical manifestations such as erythema, papules, scaling, maceration burning, itching, and stinging. In 1 study they cited, the most commonly affected areas were the nasal bridge (83%) – due to protective goggles, not facial masks – cheeks, forehead and hands.

Prolonged goggle and mask use can lead to skin conditions including contact and pressure urticaria, contact dermatitis, and aggravation of preexisting dermatides. Prolonged use of protective hats can lead to pruritus, folliculitis, or exacerbated seborrheic dermatitis. Prolonged use of gloves, as well as exaggerated hand washing with disinfectants, can lead to macerations and erosions that can potentially cause dermatitis. Study authors reported that “two-thirds of health care workers will wash their hands over 10 times a day, but only 22% are applying skin protective cream.”

Since mucous membranes have been defined as the most common point of entry for COVID-19, dermatologic patients with a compromised epidermal barrier may be at higher risk for contracting the infection during dermatology procedures or exams, the researchers noted. They pointed out that dermatologists need to be on high alert for patients with autoimmune and chronic inflammatory disorders who are taking immunosuppressive therapy, such as patients with psoriasis, atopic dermatitis, lupus, scleroderma, and hidradenitis suppurativa.

The writers of the update recommended applying skin protective cream frequently, especially before hand washing and PPE application, to prevent contact dermatitis. They also recommended dermatology practices and departments develop infection prevention measures to protect patients from an iatrogenic exposure to COVID-19. In terms of biologic treatment, they noted it was unclear whether delaying regimens is recommended.

In order to keep dermatology practices and clinics functioning during the pandemic, the investigators suggested triaging and isolating patients who come in for treatment and may have COVID-19.

“Where possible, it may prove prudent to conduct outpatient visits with teledermatology or postpone such consultations for nonemergency patients and those with fewer skin ailments,” they added.

Reference

Darlenski R, Tsankov N. COVID-19 pandemic and the skin: what should dermatologists know? Clin Dermatol. 2020;38(6):785-787. doi:10.1016/j.clindermatol.2020.03.012