Reply to: “Skin damage among health care workers managing coronavirus disease-2019”
Authors: Teresa Oranges, Agata Janowska, Valentina Dini
Journal: Journal of the American Academy of Dermatology (2020)

To the Editor: We read with interest the article "Skin damage among health care workers managing coronavirus disease-2019" written by Lan et al.1Lan J. Song Z. Miao X. et al.Skin damage among health care workers managing coronavirus disease-2019.J Am Acad Dermatol. 2020; 82: 1215-1216Abstract Full Text Full Text PDF PubMed Scopus (382) Google Scholar The main skin problems in health care managing COVID-19 and using medical devices are the hand eczema and the skin damage affecting the nasal bridge, cheek, and forehead. Lan et al1Lan J. Song Z. Miao X. et al.Skin damage among health care workers managing coronavirus disease-2019.J Am Acad Dermatol. 2020; 82: 1215-1216Abstract Full Text Full Text PDF PubMed Scopus (382) Google Scholar reported that the health care workers who wore medical devices for more than 6 hours showed higher risks of skin damage, with desquamation in more than 60% of cases, and other signs, such as erythema, maceration, and ulcers, in a smaller percentage of cases. This skin damage may cause itching and pain1Lan J. Song Z. Miao X. et al.Skin damage among health care workers managing coronavirus disease-2019.J Am Acad Dermatol. 2020; 82: 1215-1216Abstract Full Text Full Text PDF PubMed Scopus (382) Google Scholar and further impair the quality of life among health care workers. The World Health Organization recommends performing correct hand hygiene with alcohol-based hand rub (preferred in case of not visibly soiled hands) or water and soap, in particular, before touching a patient, before any clean or aseptic procedure, after exposure to body fluid, after touching a patient, and after touching a patient's surroundings.2World Health Organization & WHO Patient SafetyWHO guidelines on hand hygiene in health care: First Global Patient Safety Challenge—clean care is safer care. Geneva: World Health Organization.https://apps.who.int/iris/handle/10665/4410Date: 2009Date accessed: January 17, 2020Google Scholar The frequent hand hygiene, the use of antiseptics, and wearing of double-layers of gloves for a long time may cause the hand eczema. At the sites of application of masks, goggles, and facial shield, pressure injuries may develop, from grade 1 (nonblanchable erythema) to grade 2/3 (erosion or ulceration). The medical device–related pressure injuries may occur on any anatomic location where the medical device is in contact with the skin and particularly where the skin is over bony prominences, such as the forehead, the nasal bridge, and the zygomatic arch. The University of Pisa (Italy) Wound Healing Unit proposes the topical management of the skin areas at risk of pressure injuries in terms of cleansing, prevention, and treatment (Table I).Table ITopical management of pressure injuries in the health care worker using medical devices (masks, goggles and facial shield)Pressure injuriesTopical managementCleansing (grade 2/3)Saline solutionPolyhexamethylene biguanide (PHMB)Prevention•Before wearing medical devicesBarrier film sprayPrevention•After medical devices removalOmental lipids cream/emulsionNonadherent dressings (soft silicone/paraffin)Grade 1∗Apply after removing medical devices.Barrier film (spray/sheet)Nonadherent dressings (soft silicone/paraffin)Grade 2/3∗Apply after removing medical devices.Extra-thin hydrocolloidThin polyurethane silicone foamScar/hyperpigmentation prevention∗Apply after removing medical devices.Silicone cream/sheetPhotoprotection SPF 50+ (cream/spray/emulsion)SPF, Sun protection factor.∗ Apply after removing medical devices. Open table in a new tab SPF, Sun protection factor. The no-sting barrier film spray has shown good efficacy in the management of the skin surrounding chronic wounds, with a significant reduction of the transepidermal water loss values.3Dini V. Salibra F. Brilli C. Romanelli M. Instrumental evaluation of the protective effects of a barrier film on surrounding skin in chronic wounds.Wounds. 2008; 20: 254-257PubMed Google Scholar We suggest the use of this product before wearing the medical devices, because the alcohol-free liquid dries quickly after skin application and forms a protective, transparent, and conformable long-lasting barrier film. The use of topical products containing purified omental lipids will help in improving skin barrier function, repairing the epithelial cell membrane, and increasing microcirculation.4Romanelli M. Dini V. Milani M. Topical purified omental lipid formulations in the prevention of skin ulcers: a narrative review.J Wound Care. 2019; 28: 284-290Crossref PubMed Scopus (3) Google Scholar These products are also useful to prevent the development of pressure injuries and may be used after removing the medical devices as well the nonadherent dressings (soft silicone/paraffin). Some authors described the use of thin hydrocolloid dressing to prevent pressure injuries on the nasal bridge in case of acute noninvasive ventilation.5Bishopp A. Oakes A. Antoine-Pitterson P. Chakraborty B. Comer D. Mukherjee R. The preventative effect of hydrocolloid dressings on nasal bridge pressure ulceration in acute non-invasive ventilation.Ulster Med J. 2019; 88: 17-20PubMed Google Scholar Nonadherent dressings (soft silicone/paraffin) and extra-thin hydrocolloid may theoretically also be used before the medical devices are worn, but further studies are needed to certify that these advanced dressings do not alter the safety of the devices. Skin damage among health care workers managing coronavirus disease-2019Journal of the American Academy of DermatologyVol. 82Issue 5PreviewTo the Editor: Since the outbreak of coronavirus disease-2019 (COVID-19) in December 2019, more than 200,000 health care workers from all over China have been participating in the fight against this highly contagious disease in Hubei province, which is the center of infection in China. Skin damage caused by enhanced infection-prevention measures among health care workers, which could reduce their enthusiasm for overloaded work and make them anxious, has been reported frequently. Full-Text PDF