Covid - hand hygiene and mask acne

Covid-19 Acne and Hand Hygiene

It is imperative to ensure that hands are washed thoroughly to help prevent the transmission of infectious diseases which of course at this current time include the Coronavirus - COVID 19

However we are seeing more and more patients who are developing a hand dermatitis due to the repetitive washing of hands using a number of alcohol based products

A number of ingredients in such products are effective antimicrobials against enveloped viruses such as coronavirus - these include chloroxylenol, ethanol, povidone iodine benzalkonium chloride and chlorhexidine digluconate. However as well as being effective antimicrobials they have potential allergenicity - this is defined as an ingredient found on the American Contact Dermatitis core patch testing panels and in which either allergenicity has been reported or is rare. Ethanol and Benzethonium chloride both have not had reports to date of allergenicity. The other products have shown varying degrees of allergenicity.

In addition a lot of allergens are commonly encountered with regular hand hygiene. for example in gloves - latex and rubber accelerators, soaps and detergents contain fragrances and preservatives and hand sanitisers contain fragrances. So in some situations using rubber free gloves may be important made from nitrile or neoprene for those with rubber allergies but users can be reassured that these maintain protection against viral exposure.

Recommendations for hand hygiene

1 wash hands for 20 seconds with water and soap - using luke warm water

2 pat dry the hands not rubbing them dry

3 immediately apply a moisturiser

4 products with antibacterial ingredients are not necessary for proper hand hygiene

- use soaps that are devoid of allergenic surfactants, preservatives and fragrances

one can use synthetic detergents with added moisturisers

Use of moisturisers

avoid moisturisers in jars to prevent double dipping and potentially contaminating the product

use moisturisers packaged in tubes instead

at night apply moisturisers followed by cotton or loose plasic gloves to create an occlusive barrier

for health care workers a moisturiser under gloves can also be effective

moisturisers with a water base are safe under all gloves. however oil based moisturisers can break down latex and rubber by making material swell or become brittle. Latex, vinyl and nitrile gloves are resistant to breakdown from ethanol

Another effective option is the so called soak and smear regime - here the hands are soaked nightly in water for 20 minutes and then moisturisers are applied to damp skin nightly for 2 weeks

Quantity of moisturisers to be used -

two finger tip units is to be applied to hands after washing

Risk factors for worsening of hand eczema include -

frequent hand washing

using dish detergent or very cold water

use of disinfectant wipes

using known hand irritants such as bleach

the use of known allergens -

such as products containing topical antibitoics

using superglue for the healing of fissures

Occlusion

increased duration of glove occlusion with using underlying moisturiser

using detergents or soap on the hands without underlying moisturisers

using self adherent wraps

history of pre-existing atopic eczema

picking of dermatitis induced scale

- it is vital to follow the Government's advice on hand hygiene but to maximise benefit and to reduce hand dermatitis the above tips will keep you hands in a good condition

Mask Acne --

Masks play a vital role in reducing the spread of the coronavirus. Unfortunately they can also be harsh on the skin leading to problems which can include acne, peeling skin and itchy skin.

some tips which may help to mitigate against these symptoms include -

1 cleanse and moisturise the face daily - use fragrance free cleansers

apply a moisturiser immediately after washing your face - some moisturisers which contain ceramides, hyaluronic acid and dimethicone - have an added benefit of hydrating the skin

2 protect your lips with petroleum jelly- after washing your face, before putting a mask on and before bed - avoid the jelly on your facial skin to reduce the risk of acne breakouts

3 avoid make up when wearing a mask - if you need too then use a non comedogenic brand including mineral make up

4 avoid use of chemical peels, exfoliants and retinoids whilst using a mask - these can irritate the skin - using a retinoid at bedtime is fine

5 avoid using products which may irritate the skin with masks such as fragrances/aftershave

6 ensure the mask has a snug fit to avoid it moving and abrading the skin, use masks with two layers of fabric - the layer against your skin should be cotton. Avoid synthetic fabrics such as nylon, polyester and rayon

7 Try and take a 15 minute break after each 4 hour use of the mask

8 When washing masks use fragrant hypoallergenic detergents

- however despite all these sometimes the skin requires more intensive treatments which can be tailored for you in conjunction with your Dermatologist who you should consult