Skin issues related to protecting against COVID-19

I would like to thank everyone who joined my Instagram live session with Dr Zainab Laftah, a Consultant Dermatologist based in London, I hope you found it useful. Below is the key points from our discussions on the effects of frequent hand washing, the use of hand sanitisers and wearing masks/PPE.

Skin issues related to handwashing and sanitisers

Hand eczema

This is caused by repetitive use of hand sanitisers and handwashing leading to a compromise in the skin barrier due to loss of lipids. This presents as dry, flaky itchy red skin, typically within the finger web spaces and the knuckles. 

Simple methods such as drying your hands thoroughly after hand washing has two benefits. Firstly, it reduces the risk of infections spreading as germs are more easily transferred to and from wet hands. Secondly, water itself has a drying effect on the skin by reducing the skin’s natural oils when it evaporates, further impairing the skin barrier.

You should always apply moisturiser after handwashing. Healthcare workers alone wash their hands a minimum of 10 times per day but only 20% will remember to moisturise afterwards. Rebuild your skin barrier by moisturising your hands every time to replenish the lipids and ceramides that have been lost from the skin. These will help lock in moisture in the skin, allowing it to repair itself and become more resistant to symptoms of burning, dryness and itch. 

The WHO recommend alcohol gels should contain a minimum of 60% alcohol content to effectively kill the coronavirus. Alcohol gel hand sanitisers act quickly to kill organisms and prevent spread but should only be used when soap and water are not available. 

When treating hand eczema consider the following three essential steps;

1. Treat the eczema using a mild steroid. Often twice a day application for one week is sufficient at reducing the inflammation. 

2. Repair the skin barrier using of barrier cream (e.g. vaseline) overnight on any broken or macerated areas of skin under occlusion, such as with cotton gloves.

3. Avoid potential triggers and opt for unscented soaps designed for sensitive skin and fragrance-free moisturisers. Soaps and moisturisers that contain fragrances are particularly irritant to the skin and may give rise to an allergy.

Skin issues related to face masks and PPE

Skin issues caused by wearing face masks and personal protective equipment are becoming an increasing problem, particularly amongst healthcare professionals. There are some particular areas of concern that we can all take measures to help alleviate. 

Pressure injury from masks

Physical pressure from the mask, particularly across the nasal bridge (nose) and ears, due to the tight-fitting required and prolonged wear, is common. The pressure on skin results in redness, swelling, skin fragility and cuts. This has been reported in up to 80% of healthcare professions, particularly with N95 and FFP masks. 

In some, it induces pressure urticaria (hives) which presents as an itchy red blotchy rash, typically at sites in direct contact with the mask. 

Contact eczema

There have been reported cases of allergy to components of the mask and adhesives or rubber straps are common culprits. 

New onset or exacerbation of acne 

This is seen in up to 60%, with the face and scalp commonly affected, due to masks and protective hats. This is largely driven by 1) the hot, humid environment caused by the mask/PPE and 2) blockage of the pilosebaceous oil-producing ducts due to pressure on the skin. 

General recommendations to reduce this risk include;

1. Where possible, alleviate the pressure on the skin from the mask every few hours. Avoid using tape, as this can result in an irritant skin reaction. Avoid applying a barrier cream underneath your mask as it may affect the quality of the seal.

2.  Use a gentle fragrance-free cleanser with luke-warm water. Remember to moisturise afterwards to help to prevent water loss and improve the barrier function of the skin.

3. Avoid harsh scrubs or chemical exfoliators including retinoids if the skin is red or sensitive as this may worsen the eczema. 

4. Avoid wearing heavy make-up, especially foundation, underneath the mask as it may lead to spots.

5. Aim to use a cleanser with lactic acid or salicylic acid in the morning and evening to reduce blocked pores if you are experiencing a breakout. Also opt for a fragrance-free, non-comedogenic moisturiser to reduce the risk of clogging your pores.

6.  Take a non-sedating antihistamine daily if you are experiencing “hives”.

If you see no improvement then please see your GP or Dermatologist.

Please follow Dr Zainab Laftah’s Instagram for further updates on dermatology issues.
IG: @drzainab.dermatology