How to deal with irritated skin due to coronavirus preventive handwashing

In the weeks since news of the novel coronavirus, the COVID-19 outbreak has intensified, and the phrase "wash your hands" has quickly become a common refrain. The World Health Organization and the Ministry of Health and Family Welfare have advised people to wash their hands "often," using soap and water and counting at least 20 seconds each time, or with alcohol-based hand sanitizers. However, for individuals with particularly dry skin or skin conditions, such as eczema or psoriasis, excessive hand washing can result in skin damage and sore hands, says Dr Varshali Bhattacharya, a dermatologist at Pearl Skin Clinic, Kolkata. Even for individuals with healthy skin, overuse of soaps and hand sanitizers can cause the skin to dry out and crack, she adds.

"Repetitive use of hand sanitizers and excessive hand washing strips the skin of healthy fats and oils known as sebum, and that dehydrates the skin and causes eczema. Additionally, soaps can give rise to irritant hand dermatitis, which presents as dry, flaky, itchy red skin, particularly in the finger spaces and on the knuckles," says Dr Bhattacharya. She notes, it is important to treat these rashes, because, in addition to being itchy, inflamed, or raw, the skin is at risk for developing an infection. "Since the protective lipid layer is responsible for keeping moisture in and bacteria and irritants out, dry skin often presents with redness, flaking, itching, and even painful cracks that can leave one susceptible to infections. Any break in the skin can do this," says Dr Bhattacharya.

What is hand eczema?
Dr Bhattacharya notes that those with extremely dry skin from over-washing, under-moisturizing, or genetic predisposition can develop eczema, a skin condition that causes itchy, dry, and inflamed skin. The severity depends on the person and can manifest as flakes when mild, or a rough, cracked texture when severe, she explains. The condition can develop on many parts of the body, but is most commonly found on the inside of elbows, back of the knees, hands, and face, says Dr Bhattacharya.

Eczema has various causes, but is typically due to either a genetic predisposition, and exposure to an allergen, or a reaction to an external allergen, explains Dr Bhattacharya. "Irritant eczema is due to excess exposure to an irritant, such as soaps," she says. The skin condition is also incredibly common. "Eczema or atopic dermatitis (as it's otherwise known) is very common; it affects 20 per cent of children and 2 per cent of adults worldwide," says Dr Bhattacharya.

How to treat hand eczema?
While eczema is a chronic condition, there are certain things you can do to help relieve the symptoms, one of the biggest (and easiest) is incorporating a good moisturizer into your daily routine, says Mumbai-based dermatologist, Dr Amit Gupta. If you'd like to curb dryness and eczema in addition to practising good hygiene, Dr Gupta suggests moisturizing hands throughout the day. "Stick to a petrolatum-based moisturizer to form a protective, but breathable seal over the skin. Use a skin lotion that is easy to spread and does not leave the skin feeling greasy," he says.

Individuals with preexisting skin conditions are more at risk of skin damage. These people "may benefit from hand-washing with a moisturizer that contains an antibacterial ingredient, for example, chlorhexidine or benzalkonium chloride," says Dr Gupta. However, he notes that a recent study reported that "hand sanitizers containing these biocidal ingredients were less effective than alcohol-based hand gels at eradicating the coronavirus."

Besides moisturizing, it is also important to dry hands thoroughly. This is important for two reasons: firstly, germs are transferred more easily between wet hands. Secondly, as Dr Gupta explains, "water itself has a drying effect on the skin by reducing the skin’s natural oils when it evaporates, thus impairing the skin barrier."

How to wash your hands if you have eczema?
Overall, Dr Gupta recommends either of the following two options:
• Wash with soap and water, then moisturize. He adds that a "moisturizer that lathers can act as a soap substitute and will be less drying on the hands; therefore, those with cracked skin may find this more soothing."
• Use an alcohol-based hand sanitizer and then moisturize afterwards. Moisturizing at the same time might compromise the anti-microbial properties of the hand sanitizer. "If patients feel the need to use a sanitizing gel, (this may exacerbate the eczema or skin condition), then apply an emollient cream or spray immediately afterwards to minimize skin irritation."

Of course, dry skin is a small price to pay for a crucial health and safety measure. Dermatologists themselves wash their hands dozens of times each day. Dr Bhattacharya, for example, estimates that she washes her hands a minimum of 30 times each day, more when seeing patients. But, if you develop a rash that doesn't improve over time, consult your dermatologist. Regardless of your situation, she recommends following the advice to "wash hands regularly, minimise touching the face and avoid contact with people who may be unwell."