Rational hand hygiene during the coronavirus 2019 (COVID-19) pandemic
Authors: Gregory Cavanagh, Carlos Gustavo Wambier
Journal: Journal of the American Academy of Dermatology (2020)

To the Editor: The enhanced preventive measures during the SARS-CoV-2 coronavirus disease 2019 (COVID-19) pandemic include proper hand hygiene. Health care workers (HCWs) may perform frequent handwashing with water and soap, leading to the potential complication of skin damage. In Lan et al's survey1Lan J. Song Z. Miao X. et al.Skin damage among healthcare workers managing coronavirus disease-2019.J Am Acad Dermatol. 2020; 82: 1215-1216Abstract Full Text Full Text PDF PubMed Scopus (382) Google Scholar of 526 front-line COVID-19 HCWs, 74.5% reported damage to hand skin from enhanced infection prevention measures. HCWs who washed their hands more than 10 times per day reported more damage to hand skin (odds ratio, 2.17). This skin damage creates a route of entry for COVID-19, and basic skincare measures should be taken after handwashing to address this. Notably, the cell receptor for SARS-CoV-2 entry, angiotensin-converting enzyme 2 (ACE2), is abundantly present in blood vessels/capillaries of the skin, the basal layer of the epidermis, and hair follicles. ACE2 is also present in eccrine glands.2Hamming I. Timens W. Bulthuis M.L.C. Lely A.T. Navis G.J. van Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis.J Pathol. 2004; 203: 631-637Crossref PubMed Scopus (4244) Google Scholar Yan et al.3Yan Y. Chen H. Chen L. et al.Consensus of Chinese experts on protection of skin and mucous membrane barrier for healthcare workers fighting against coronavirus disease 2019.Dermatol Ther. 2020; ([Epub ahead of print]) (Accessed March 13, 2020): e13310https://doi.org/10.1111/dth.13310Crossref PubMed Scopus (215) Google Scholar discuss several measures that can be done to avoid hand eczema, maceration, and erosion due to PPE and handwashing during the pandemic. Qualified sanitizers with ethanol as the main component are prioritized for hand decontamination, and the application of hand cream/moisturizers on intact skin after hand washing is instructed.3Yan Y. Chen H. Chen L. et al.Consensus of Chinese experts on protection of skin and mucous membrane barrier for healthcare workers fighting against coronavirus disease 2019.Dermatol Ther. 2020; ([Epub ahead of print]) (Accessed March 13, 2020): e13310https://doi.org/10.1111/dth.13310Crossref PubMed Scopus (215) Google Scholar During handwashing, overly-hot water can lead to contact dermatitis and should therefore be avoided. Hypoallergenic moisturizers, gloves, and alcoholic hand sanitizers are vital to prevent hand eczema. Educational intervention about hand-eczema risk factors—such as frequent hand washing, surgical scrubbing, and prolonged glove use—was shown to promote hand-skin health among HCWs.4Gasparini G. Carmisciano L. Giberti I. Murgioni F. Parodi A. Gallo R. "HEALTHY HANDS". A pilot study for the prevention of chronic hand eczema in healthcare workers of an Italian University Hospital.G Ital Dermatol Venereol. 2019; ([Epub ahead of print]) (Accessed June 12, 2019)https://doi.org/10.23736/S0392-0488.19.06220-5Crossref PubMed Scopus (7) Google Scholar Due to the risk of hand-skin damage, rational hand-hygiene measures respectful of the skin along with proper use of protective gloves and moisturizers must be instructed to HCWs during the fight against COVID-19. 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 Personal protective equipment recommendations based on COVID-19 route of transmissionJournal of the American Academy of DermatologyVol. 83Issue 1PreviewTo the Editor: Cavanagh and Wambier1 have written an informative article on how dermatologists may approach hand hygiene during the coronavirus disease 2019 (COVID-19) pandemic. They describe the risk of hand dermatitis in health care workers faced with a sudden increase in frequency of hand washing. They appropriately recommend measures to decrease this risk, such as applying hypoallergenic moisturizers and not rinsing with hot water. Full-Text PDF