Hand eczema & hand hygiene during COVID-19: doing the best under the circumstances

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In March 2020 the World Health Organization (WHO) declared the outbreak of SARS-CoV-2 (COVID-19) to be a pandemic. As of 14 March 2021, more than 119 million cases have been confirmed, with more than 2.64 million deaths attributed to COVID-19, making it one of the deadliest pandemics in human history. Various preventative measures are recommended by the WHO and Centre of Disease Control. These include, but are not limited to, social distancing, wearing of face masks, covering one’s mouth when sneezing or coughing, surface decontamination and frequent and proper handwashing. The WHO recommends washing one’s hands with water and soap for at least 20 seconds many times a day. If water and soap is not available, the recommendation is to apply hand sanitizer containing at least 60% alcohol. It is advised to rub the gel over all surfaces of the hands until it is dry.

This of course speaks directly against what is advised for the management of hand dermatitis/eczema (HE). HE has various causes but when we refer to HE in this piece we are referring to atopic dermatitis/eczema (AE) involving the hands. As is always advised with AE avoiding water and soaps that foam is of critical importance to protect the barrier function of the skin. Hand sanitizers were also discouraged, before the dawn of this life-changing pandemic of course. Not only can hand sanitizers and frequent hand washing exacerbate existing hand AE, it can also trigger the first appearance of hand AE. If a person is prone to develop eczema but always look after their skins well, they may be able to prevent the development of the condition. But throw in some obligatory hand washing and frequent hand sanitizing and, voila, there you see the appearance of HE.

For those of us who already had HE before March 2020 this pandemic offers different types of challenges. At the entrance of every shop, restaurant, business, school, hospital …you name it… we are obliged to apply the hand sanitizers provided. If not, one is denied entry – and rightly so. The sanitizer causes burning when in contact with the cracks and the breaks in the skin puts the HE sufferer at higher risk of the development of COVID-19 with the virus gaining access to the body through the cracks in the skin.

How to attempt to address this problem:

There is unfortunately no easy answer to this problem. Avoiding washing of hands and application of hand sanitizer could potentially put the HE sufferer at risk of contracting a potentially deadly disease. Wearing surgical gloves daily could lead to a false sense of security as the gloves are useless at protecting against the corona virus as soon as exposed to hand sanitizers containing 60% alcohol or more. People then also forget that all the germs are sitting on the gloves and touch their faces or even eats with their gloved hands. The risk of wearing these gloves constantly – especially if they are latex gloves – is that this could lead to latex allergies in the long run.

Here are some tips:

1. When washing your hands use your soap substitute rather than soap. Make sure to rub your hands while washing with your soap substitute for 20 seconds. Hereby you are harnessing the physical means of removing any contaminants from your hands. Make sure to dry your hands properly after the wash.
2. Apply your moisturizer directly after washing, after applying your hand sanitizer as well as many more times during the day.
3. It is recommended that hand sanitizers contain some moisturizing ingredient as well, whilst ensuring that the sanitizer still contains at least 60% alcohol. Look out for hand sanitizers containing glycerol as a moisturizer. Take your own sanitizer with when going to shops and demonstrate at the entrance that you are applying your own sanitizer.
4. Control your HE by stepping up your cortisone ointment during this challenging time. Cracks in the skin with HE is a consequence of poorly controlled eczema. If you manage your condition aggressively, your chances of getting through this time of regular hand washing and sanitizing are increased. You may have to see your doctor for some advice on this.

This is unfortunately not ideal treatment situation for HE, but it’s the best that we can do during this worldwide pandemic. If all else fails, remember: ‘Moisturize, moisturize, moisturize. And when you think you’ve moisturized enough: moisturize once more!’