Correspondence Address:
Anupam Das
Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal
India

Full Text



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}

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