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 survey1 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.2
Yan et al.3 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.3 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.4
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.
Footnotes
Funding sources: None.
Conflicts of interest: None disclosed.
IRB approval status: Not applicable.
Reprints not available from the authors.
References
- 1.Lan J., Song Z., Miao X., et al. Skin damage among healthcare workers managing coronavirus disease-2019. J Am Acad Dermatol. 2020;82(5):1215–1216. doi: 10.1016/j.jaad.2020.03.014. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Hamming 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;203:631–637. doi: 10.1002/path.1570. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Yan 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:e13310. doi: 10.1111/dth.13310. [Epub ahead of print] Accessed March 13, 2020. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Gasparini 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 doi: 10.23736/S0392-0488.19.06220-5. [Epub ahead of print] Accessed June 12, 2019. [DOI] [PubMed] [Google Scholar]