Indian Journal of Dermatology
  Publication of IADVL, WB
  Official organ of AADV
Indexed with Science Citation Index (E) , Web of Science and PubMed
 
Users online: 505  
Home About  Editorial Board  Current Issue Archives Online Early Coming Soon Guidelines Subscriptions  e-Alerts    Login  
    Small font sizeDefault font sizeIncrease font size Print this page Email this page


 
Table of Contents 
CORRESPONDENCE
Year : 2021  |  Volume : 66  |  Issue : 2  |  Page : 218-220
An upsurge of hand dermatitis cases amidst COVID-19 pandemic


1 Department of Dermatology, JP Hospitals, Rourkela, Odisha, India
2 Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal, India
3 Department of Dermatology, RG Kar Medical College and Hospital, Kolkata, West Bengal, India

Date of Web Publication16-Apr-2021

Correspondence Address:
Anupam Das
Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.IJD_631_20

Rights and Permissions



How to cite this article:
Kar D, Das A, Sil A. An upsurge of hand dermatitis cases amidst COVID-19 pandemic. Indian J Dermatol 2021;66:218-20

How to cite this URL:
Kar D, Das A, Sil A. An upsurge of hand dermatitis cases amidst COVID-19 pandemic. Indian J Dermatol [serial online] 2021 [cited 2021 May 11];66:218-20. Available from: https://www.e-ijd.org/text.asp?2021/66/2/218/313766




Sir,

In the background of COVID-19 pandemic, maintenance of hand hygiene has gathered unprecedented attention to prevent the spread of the virus.[1] Although the awareness of the importance of hand hygiene in preventing infection with the COVID-19 virus is high, the panic that has set in has also made people use soap water and alcohol-based sanitizers more enthusiastically than that is actually required, making them prone to develop hand eczema because of the loss of protective mantle of the skin.

We came across multiple cases of recalcitrant hand dermatitis over the last few weeks. [[Figure 1]a, [Figure 1]b, [Figure 1]c, [Figure 1]d, [Figure 1]e, [Figure 1]f All of them were performing repeated hand hygiene activities (either with an alkaline non-pH balanced soap or alcohol-based sanitizers). There was no previous history of atopic dermatitis (personal or familial) or hand eczema in any of the cases. They were prescribed moisturizers and symptomatic treatment (topical corticosteroids and topical antifungals as per the requirement).
Figure 1: Various manifestations of hand dermatitis showing (a) hyperkeratotic hand eczema due to cumulative irritant-contact dermatitis, (b) erythema and excessive scaling due to repeated use of hand sanitizers, (c) excerbation of candidiasis in a patient with obsessive-compulsive disorder (OCD), (d) lichenified plaques over dorsa of hand, (e) lichenification and xerosis over the dorsum of hands, (f) allergic contact dermatitis due to use of latex gloves in a healthcare worker

Click here to view


Hand hygiene involves washing with soap and water or alcohol-based hand sanitizers but repeated hand washing can lead to irritant-hand dermatitis, which may decrease compliance, negating the very purpose of hand hygiene. The elements of hand hygiene including friction, rubbing, water, towel drying, surfactants, and disinfectants have considerable effects on the epidermal barrier. Water alone can remove the free amino acids, the components of the natural moisturizing factor responsible for maintaining sufficient hydration for stratum corneum plasticization and desquamation.[2]

Skin pH increases immediately after water contact.[2] An acidic pH is necessary for the effective functioning of enzymes responsible for the synthesis of stratum corneum and maintaining lipid metabolism, bilayer structure, ceramide synthesis, and desquamation.[3] The presence of atopic diathesis, low humidity, frequency of hand washing, wet work, use of gloves, and duration of employment are important risk factors for the development and/or aggravation of hand dermatitis.[4]

Frequent exposure to soap/surfactant cleansers and water has significant effects on skin structure and function, including the disruption of the lipid bilayer composition and structure, epidermal inflammation, and increased permeability. Hence, a pH (5.5) balanced soap instead of regular alkaline soaps may help in maintaining skin integrity, especially upon the requirement of frequent washing.

The strategies to combat hand dermatitis due to frequent hand washing include identification of risk factors, rinsing the hands by soft and non-aggressive maneuvers, without causing physical irritation to skin, applying moisturizers (multiple times a day and immediately after hand washing), especially during time off (thick greasy creams and ointments may be better, use of alcohol hand rubs whenever possible, provision of hand wash products with low irritancy surfactants, and continuing education about hand hygiene practices and effects on healthcare-associated infections). Short courses of topical corticosteroids may be prescribed to individuals with highly sensitive skin.[5] Since it is difficult to quantify the number of times we can wash our hands, it is making people believe that more is better, leading to increased incidences of hand dermatitis and super-added infection. The authors are conducting regular webinars and circulating short video clips regarding the techniques of hand washing and outlining the do's and dont's with respect to this routine procedure.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Das A, Kumar S, Sil A, Jafferany M. Skin changes attributed to protective measures against COVID-19: A compilation. Dermatol Ther 2020;33:e13796.  Back to cited text no. 1
    
2.
Robinson M, Visscher M, Laruffa A, Wickett R. Natural moisturizing factors (NMF) in the stratum corneum (SC). II. Regeneration of NMF over time after soaking. J Cosmet Sci 2010;61:23-9.  Back to cited text no. 2
    
3.
Schmid-Wendtner MH, Korting HC. The pH of the skin surface and its impact on the barrier function. Skin Pharmacol Physiol 2006;19:296-302.  Back to cited text no. 3
    
4.
Darlenski R, Tsankov N. COVID-19 pandemic and the skin: What should dermatologists know? Clin Dermatol 2020;38:785-7.  Back to cited text no. 4
    
5.
Beiu C, Mihai M, Popa L, Cima L, Popescu MN. Frequent hand washing for COVID-19 prevention can cause hand dermatitis: Management tips. Cureus 2020;12:e7506.  Back to cited text no. 5
    


    Figures

  [Figure 1]



 

Top
Print this article  Email this article
 
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (814 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    References
    Article Figures

 Article Access Statistics
    Viewed166    
    Printed0    
    Emailed0    
    PDF Downloaded7    
    Comments [Add]    

Recommend this journal