Frequent Hand Washing for COVID-19 Prevention Can Cause Hand Dermatitis: Management Tips

Abstract

Coronavirus disease 2019 (COVID-19) continues to spread globally, outpacing the capacity and resources of health systems worldwide. A therapeutic vaccine is not yet on the rise, and preventive measures are the current approach to restraint the transmission of cases. As the virus is highly contagious via respiratory route (droplets from infected persons, widely spread by coughing or sneezing) and via contact with contaminated surfaces, community transmission and spread can be decreased through the practice of regular and diligent hand hygiene. Frequent hand washing implies a prolonged exposure to water and other chemical or physical agents and may induce several pathophysiologic changes, such as epidermal barrier disruption, impairment of keratinocytes, the subsequent release of proinflammatory cytokines, activation of the skin immune system, and delayed-type hypersensitivity reactions. Adverse dermatologic effects, such as excessive skin dryness or even contact dermatitis (particularly the irritant subtype and, to a lesser extent, the allergic subtype), can occur, especially in individuals with a history of atopic dermatitis. These skin conditions are perfectly manageable, and applying a moisturizer immediately after washing hands or after using a portable hand sanitizer is the cornerstone in preventing the development of eczematous changes in the hands. In the current global context, the potential occurrence of these dermatological adverse events should in no way cause people to deviate from strict hand hygiene rules.

Keywords: contact dermatitis; covid-19; hand dermatitis; prevention.

Figure 1. Clinical characteristics of irritant contact dermatitis in a 38-year-old patient who adopted frequent hand washing habits a month ago, as a preventive measure for COVID-19 spread, without using moisturizers.

The white asterisks (*) highlight several ill-defined, xerotic (dry), erythematous scaly patches on the dorsum of the hands, fingertips, and finger webs, which progress to lichenification (skin thickening).

Figure 2. Eczematous skin changes on the hand of a 19-year-old Asian male, with a personal history of atopic dermatitis.

The patient initiated preventive hand washing measures two months ago, without hydrating the hands afterward and developed severe skin dryness, fissuring (white arrow), and scaling.  Also the irritant-induced changes have progressed to hyperkeratosis and acanthosis (black arrows), highlighting the cumulative exposure.

Figure 3. Clinical features of allergic contact dermatitis.

Confluent, erythematous, scaly itchy patches, with small vesicles (highlighted in the white circles), on the hands of a patient with allergic reaction induced by chemicals in detergents and soaps.