Skin damage due to protective measures: frequent handwashes & daily use of masks

Occupational dermatitis: a frequent pathology among healthcare staff^1,2

Irritant dermatitis, contact urticaria and contact eczema are frequent among healthcare workers. Humid environment, disinfectant handling, frequent handwash alter cutaneous barrier and result most commonly in irritant dermatitis.

Recurrent contact with materials and chemicals, such as gloves (natural rubber latex, thiurams) or disinfectant products (glutaraldehyde, dodecyldimethylammonium) can also cause sensitization in predisposed subjects who, in turn, develop allergic contact dermatitis.

What about skin damage among healthcare workers during COVID-19 pandemic?³

COVID 19-related preventive measures, such as wearing gloves or washing hands frequently, can logically cause more skin damage on multiple areas among healthcare workers. Such attacks could compromise their effectiveness on the job and reduce their enthusiasm when facing a work overload.

A few authors looked into this issue. They aimed to estimate the prevalence of clinical features and risk factors in regards to skin damage among healthcare workers during COVID-19 epidemic period. They took into consideration enhanced frequent hand hygiene as well as long periods of time wearing multiple protective devices (mask, goggles, face shield, double layers of gloves).

From January to February 2020, self-administered online questionnaires were distributed to 700 healthcare workers (physicians, nurses) working in designated areas in Hubei (China). Questions focused on skin damage conditions and infection prevention measures (frequency, duration).

In the end, 542/700 workers (77.4%) completed the study: 71.4% (387/542) working in isolation COVID-19 units and 28.6% (155/542) in fever clinics.

An extremely high prevalence^3,4

97% is the skin damage prevalence rate caused by infection prevention measures and experienced by healthcare staff on the front line.

Of note, this rate is much higher than the occupational contacat dermatitis rate in healthcare workers under normal conditions (31.5%). It is even higher than the adverse skin reaction rate observed during the SRAS outbreak (21.4-35.5%).

What were the main clinical features?

Damaged skin areas³

Signs and Symptoms³

Dryness/tightness and desquamation were the most common symptom and signs

Clinical Feaures* (symptoms in green, skin lesion in blue):

Is there a link between skin damage and exposure factors?

Exposure time^3,4

Wearing medical devices (aside from face shield) for more than 6 hours a day was a risk factor for skin damage in corresponding areas.

In a previous study conducted during the SRAS epidemic, Foo et al. revealed that 35.5% of healthcare workers regularly using N95 masks experienced acne, facial dermatitis, pigmentation, etc.

Dermatitis with pruritus was mostly due to irritant chemicals when allergic contact dermatitis was caused by adhesive or other mask parts (rubber traps, metal strips).

Hand hygiene^3,5-6

Extreme hand hygiene (>10 times a day) appeared to be more detrimental to hand skin (OR: 2.17, p <0.01)than wearing gloves for a long period of time.

Another study conducted in Wuhan reported skin reactions in 74.5% respondents (N=280/376) and similar results in terms of risk factors.

In this study, a higher prevalence of adverse skin reactions was observed in healthcare staff working in hospitals with more severe epidemic and inpatient wards compared with those working in hospitals with less severe epidemic and fever clinics. One possible explanation was longer working hours, as prolonged use of PPE itself is a risk factor for adverse skin reactions.

Considering that high damage level is directly linked to long exposure time, and consequently responsible for a decreased effectiveness in care, it would be necessary in such circumstances to think about sensible working time arrangements (when possible), as well as promoting education and searching prophylactic dressing to alleviate device pressure on injuries.