March 2020

Excessive dryness or eczema due to hand washing

As coronavirus fears continue to circulate and we see rising cases in the UK, it only makes sense to follow current recommendations surrounding the importance of hand hygiene and washing practices.  However, repeated cleansing and use of alcohol gel has resulted in nearly all of my patients this week in suffering with some degree of either excessive dryness or very active hand dermatitis (eczema).

Repeated use of soaps, detergents and alcohol gel are a common and important cause of what is known as irritant contact dermatitis.  These products can damage proteins in the upper layer of our epidermis (stratum corneum), cause changes in the lipids or fats in our skin, prevent skin cells sticking together appropriately and reduce the water binding capacity of our skin.  In extreme cases, changes may occur to our skin microbiome resulting in secondary bacterial infection (e.g. colonisation with bacteria such as Staphylococci).

Clinically, the hands can become red, rough, scaly, dry, cracked, and fissured (where small cuts appear in the skin).  You may feel the hands have a burning or tingling sensation or feel itchy and irritated.  In severe cases the skin may become blistered, painful and form crusts.  This problem can develop in anyone who is frequently washing their hands - which is probably all of us right now!  Those at high risk often have a background of eczema already or work in an occupation which involves frequent hand washing already (e.g. healthcare professionals) or exposure to chemicals or irritants (e.g. hairdressers, beauticians, agricultural workers).

So what can you do when hand washing is key in reducing transmission of disease?  Well, there are measures which can be taken to reduce the risk of hand dermatitis developing as well as appropriate treatment if the problem has already occurred.

Top tips for hands with eczema or dryness:

1. Make sure you carry a non-fragranced hand cream at all times and get into the habit of moisturising after washing. Fragrances can potentially worsen dermatitis so as a rule of thumb, if it smells good, unfortunately you probably want to stay away from it for active hand eczema.
   
   
2. Ideally use soap and water to wash your hands at home and leave alcohol gel for when you’re out and about.
   
   
3. Buy some cotton gloves and before sleep at night apply a generous layer of hand cream to both hands before placing them into the gloves whilst you sleep overnight.  This is almost like doing an intense “hand mask” providing relief for chapped skin.
   
   
4. If you are cleaning or washing up then protect the hands from irritants or chemicals and wear gloves.  Try not to get the hands wet or irritated any more times than is absolutely necessary.
   
   
5. Wear gloves outside!  The weather is cold right now and cold air and exposure to the elements can further worsen dryness and hand eczema.  The rest of our body is protected by clothing but our face and hands bear the brunt of environmental exposure to cold, wind and pollution.
   
   
6. If the skin is itchy, cracked or bleeding then please seek help from your GP or dermatologist.  Once hand eczema becomes problematic, it may require treatment with a short, sharp burst of topical steroid treatment which requires prescription.  When used for appropriate periods of time under expert guidance you should not suffer with any long-term side effects of steroid use.  The purpose of the steroid ointment is to reduce inflammation and allow the skin to heal and recover.  If treatment is not offered, the eczema will not only cause discomfort, but may restrict your daily activities and the skin becomes vulnerable to infection as it is no longer functioning appropriately as a barrier.

The British Association of Dermatologists has also offered recent guidance on this topic as I think all dermatologists are seeing this problem rising in their clinics. 

Dr Anjali Mahto, Consultant Dermatologist & British Skin Foundation spokesperson

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