Table III.

American Contact Dermatitis Society hand hygiene recommendations

Use of soaps and synthetic detergents •Wash hands with lukewarm or cool water and soap for at least 20 seconds. •Avoid hot and very cold water. •Nonfrictional, pat drying (don't rub). •Immediate application of moisturizer after cleansing practices is recommended. •Products with antibacterial ingredients are not necessary for proper hand hygiene. •Look for soaps or synthetic detergents that are devoid of allergenic surfactants, preservatives, fragrances, or dyes. •Look for synthetic detergents with added moisturizers. •Dry hands are common with frequent use of soaps or synthetic detergents.

Use of ABHS •At least 60% alcohol is recommended. •Look for hand sanitizers that are devoid of allergenic surfactants, preservatives, fragrances, or dyes. •Look for ABHSs with added moisturizers. •Dry hands are common with frequent use. Application of a moisturizer after hand washing is recommended.

Use of moisturizers •Avoid moisturizers in jars to prevent double dipping into and potentially contaminating the product. •Use moisturizers packaged in tubes instead. •Look for pocket-sized moisturizers to keep on one's person for frequent reapplication. •At night, apply moisturizer followed by cotton or loose plastic gloves (eg, plastic clear, disposable food gloves) to create an occlusive barrier. •For health care workers, a moisturizer under gloves can also be effective. Moisturizers with a water base are safe under all gloves; however, oil-based moisturizers can break down latex and rubber by making the material swell or become brittle. •Latex, vinyl, and nitrile gloves are resistant to breakdown from ethanol or isopropyl alcohol. •Soak and smear: soak the hands in plain water for 20 minutes and immediately apply moisturizer of choice to damp skin nightly for up to 2 weeks.

Glove ACD •For glove ACD, accelerator-free gloves should be used, such as rubber-free neoprene or nitrile gloves. •Apply moisturizer after washing hands and before wearing gloves. •Consider a cotton glove liner or loose plastic gloves (eg, plastic clear, disposable food gloves). •Individuals with suspected hand ACD should be patch tested.

Treatment of hand dermatitis • ACD ○ For hand dermatitis that is allergic in nature, allergens should be identified and avoided. ○ Application of a topical steroid may be recommended to mitigate flares of dermatitis. ○ Individuals with recalcitrant hand dermatitis should seek a dermatology consultation and be evaluated for patch testing. ○ Individuals with suspected ACD should be patch tested to evaluate for a clinically relevant causal allergen. ○ For recalcitrant cases, a stronger topical steroid, phototherapy, systemic therapy, or occupational modification may be necessary. • ICD ○ For hand dermatitis that is irritant in nature, awareness of the irritating nature of wet work and exposure to surfactants and detergents is imperative. ○ Irritants should be identified and avoided. ○ The use of barrier creams (eg, restorative creams such as humectants) may be helpful; however, their use is equivalent to regular moisturizers. ○ Switching to less-irritating products should be attempted. ○ Application of a topical steroid can be considered if conservative measures fail; however, consider potential topical steroid-induced damage to the skin barrier. ○ Individuals with recalcitrant hand dermatitis should seek a dermatology consultation. ○ For recalcitrant cases, phototherapy, systemic therapy, or occupational modification may be necessary.

Risk factors for induction or worsening of hand ACD and/or ICD • Hand washing ○ Frequent hand washing ○ Washing hands with dish detergent or other known irritants ○ Washing hands with very hot or very cold water ○ Use of disinfectant wipes to clean hands ○ Working with known irritants such as bleach • Application of known allergens • Products containing topical antibiotics (eg, neomycin, bacitracin) • Applications of superglue (ethyl cyanoacrylate) to glue inflammatory or healing fissures • Occluding fingers with adhesive bandage impregnated with bacitracin or benzalkonium chloride • Occlusion ○ Increased duration of glove occlusion (without underlying moisturizer application) ○ Hands treated with a detergent or soap before glove occlusion (without underlying moisturizer application) ○ Occluding hands with self-adherent wraps • Underlying skin disease • Pre-existing atopic dermatitis of the hands • Picking at dermatitis-induced scale

ABHS, Alcohol-based hand sanitizer; ACD, allergic contact dermatitis; ICD, irritant contact dermatitis.