Celestine Wong is a consultant dermatologist at Monash Health. Rosemary Nixon is a honorary clinical associate professor at the University of Melbourne. This story originally featured on The Conversation.
Washing your hands is one of the crucial ways we can all help limit the spread of COVID-19.
Regularly and thoroughly washing your hands with soap and water for at least 20 seconds or using an alcohol-based hand sanitizer are key steps to reducing the risk.
But with all this hand washing, it’s easy to get dry skin or for existing skin conditions to flare up.
What’s happening to our skin?
The top layer of our skin (the stratum corneum) is our skin’s key protective layer. But frequent hand washing with repetitive exposure to water, soap, and skin cleansers will disrupt this layer.
Over time, this leads to dry skin, further disruption of the skin barrier, and inflammation.
This eventually results in hand dermatitis, or more specifically, irritant contact dermatitis.
Who’s most likely to experience this?
Irritant contact dermatitis is more common in people who perform “wet work” as they wash and dry their hands many times a day.
They include health care workers (doctors, nurses, personal care assistants), hairdressers, food handlers, kitchen staff, and cleaners. They may also be exposed to irritating skin cleansers and detergents.
But now hand washing is becoming more frequent during the COVID-19 pandemic, there may be more affected people outside these occupations.
People with eczema, asthma, and hay fever are also at higher risk of developing irritant contact dermatitis or experiencing a flare of underlying eczema.
How do I prevent hand dermatitis?
Soap, soap alternative, or hand sanitizer
People with eczema or who have had contact dermatitis before will have more easily irritated skin. While they can still use hand sanitizers, it’s recommended they wash with gentler soap-free cleansers rather than normal soap.
Soap-free cleansers contain non-soap-based synthetic detergents (syndets). Syndets have a nearly identical sanitizing action as soap, but with the benefit of having the same pH as the skin. This means they’re less likely to remove the oils from the outer layer of the skin and are less irritating.
Soaps have a high pH and are quite alkaline. This disrupts the outer layer of the skin, allowing the soap to penetrate deeper into the skin, thus causing more skin irritation and itching.
Other people who don’t have eczema or a history of contact dermatitis should just use soap. Liquid soaps usually contain fragrances and preservatives, which can cause another type of dermatitis (allergic contact dermatitis), so opt for a plain, unperfumed bar soap.
Dry your hands thoroughly
Dry your hands thoroughly, including the webs of your fingers and under your rings to reduce dermatitis caused by trapped water. Skin irritation and breakdown can occur when there is excessive moisture, soap residues, and water trapped between the skin and underneath rings.
Use non-fragranced moisturizer regularly
Moisturizers come in different formulations. While lotions are light in consistency and convenient to use during the day, they will require more frequent applications. Creams and ointments have thicker and oilier texture, are effective for dry hands, and are best used overnight.
Fragrances can cause allergic contact dermatitis and are best avoided, where possible.
Use alcohol-based hand sanitizer (if you can get hold of it)
Alcohol-based hand sanitizer will reduce your skin’s contact with water, and so lower your risk of dermatitis. It can be a good option when you’re out of the home and don’t have access to a hand washing sink.
Research in health- are workers shows hand sanitisers cause less contact dermatitis than washing with soap and water.
Sometimes people wrongly believe that when hand sanitizer stings on a paper cut, this means that they are allergic. But this is an irritant reaction and though uncomfortable, it’s safe to keep using it.
Which sanitizer? This usually comes down to personal preference (and what you can get hold of).
Wear protective gloves when doing household chores, such as washing the dishes or when gardening.
Wear cotton gloves when doing dry work, such as sweeping or dusting, to protect your hands and minimise the need to wash them.
At night, moisturize your hands, then wear cotton gloves. This acts like an intensive hand mask and works wonders for very dry skin. It ensures the moisturizer stays on your hands and increases its penetration into your skin.
What if my hands are already damaged, dry, or cracking?
Treat hand dermatitis as soon as it occurs, otherwise it will get worse. If you think you’ve lost your nail cuticle (the protective barrier between the nail and nail fold), water will be able to seep into the nail fold, causing swelling and dermatitis.
Use petroleum jelly, such as Vaseline, as a sealant to prevent further water damage. Petroleum jelly can also be used on skin cracks for the same reason.
If there are any red, dry and itchy areas, indicating active dermatitis, seek help from your GP or dermatologist. They can start you on a short burst of an ointment that contains corticosteroids until the rash subsides.
Prescription ointments are likely to be more effective than over-the-counter creams because of their higher potency. But you could start with buying 1 percent hydrocortisone ointment, not cream, from the chemist.
Sometimes dermatitis can become infected with skin bacteria such as Staphylococcus aureus. Seek medical advice if you experience symptoms such as persistent soreness or pain. You should also seek medical help if you have severe hand dermatitis that’s not responding to home treatments.
Most GPs and dermatologists are moving to or have started using telehealth so you can consult them using a video call, minimizing face-to-face appointments.