The Prevalence and Determinants of Hand and Face Dermatitis during COVID-19 Pandemic: A Population-Based Survey

A comparative study on the effect of alcohol-based hand sanitizers in spray and gel formulation on the skin: A prospective, randomised, crossover trial

BACKGROUND

Many formulations of Alcohol-based hand rubs (ABHRs), such as liquid, gel, and spray have been developed and used for preventing infections. This study aimed to compare skin irritation from using ABHRs in gel and spray formulations.

METHOD

This was a prospective, randomised, crossover trial conducted to investigate the effect of skin irritation caused by ABHRs in gel compared to spray formulation after 21 days of using each formulation. Clinical outcomes were assessed using subjective Larson's skin assessment score and Frosch and Kligman observer skin assessment score, as well as bioengineering measures: transepidermal water loss (TEWL) and skin capacitance on days 3, 7, 14, and 21.

RESULTS

Among 38 participants, both formulations showed no significant change in clinical scores and skin capacitance during the study. However, TEWL increased significantly from baseline on day 3 (p = 0.029) for the spray formulation and on day 21 (p = 0.019) for the gel formulation, with no statistically significant difference between the formulations (p = 0.46).

CONCLUSION

Our research supports the safety of gel and spray ABHRs for regular use, with the only potential issue being mild skin irritation. For those with sensitive skin, the gel formulation is preferable.

Adult and children's use of hand sanitizer during a pandemic - an observational study

BACKGROUND

The use of hand sanitizers has been one of the key public health measures recommended to reduce the transmission of SARS-CoV-2 during the pandemic. As such, its daily use among the general population has reportedly increased dramatically since the onset of the COVID-19 pandemic.

OBJECTIVE

To better understand the impact of this recommendation, hand sanitizer use, including the frequency and amount handled, was examined among adults in a non-occupational setting and children in both the home and school/childcare settings.

METHODS

An online survey of Canadians (conducted from September to October 2021) was employed to estimate use frequency, amount, and pattern of hand sanitizer use.

RESULTS

Responses were received from 655 adults in the general population and 298 teachers of children up to the age of 18 years. The frequency of hand sanitizer use during the pandemic was found to be as high as 25 times per day in children and over 9 times per day in adults. Notable differences were found when comparing the frequency of hand sanitizer use by children in the home to children in a school or childcare setting.

SIGNIFICANCE

This is the first study, known to the authors, examining hand sanitizer use among children during the pandemic, including use in a childcare or school setting. This study illustrates the importance of examining the change in consumer behaviors during a pandemic and the need to look beyond the home when attempting to understand product use patterns in children.

IMPACT STATEMENT

This research explores uses of hand sanitizer, before and during pandemic conditions, in the general population of Canada with a particular focus on use among children. The results can be used to estimate exposure to chemicals in hand sanitizer from non-occupational use in Canada and among similar populations and signal the importance of examining changing consumer behaviors and use of consumer products in school settings, especially among children.

Contact dermatitis caused by prevention measures during the COVID-19 pandemic: a narrative review

Introduction

During the outbreak of Coronavirus disease 2019 (COVID-19), health care workers wore personal protective equipment including masks, gloves and goggles for a long time. In order to reduce the transmission routes of the virus, public places were sprayed with disinfectant. Moreover, the body, hands and clothing were frequently disinfected and washed for hygiene purposes. Studies have shown that these practices could easily irritate the skin and damage the skin barrier. Long-term irritation or exposure to allergens may lead to the occurrence of contact dermatitis (CD).

Methods

Subject headings were searched via the National Library of Medicine (PubMed) and web of science databases: COVID-19; contact dermatitis; adverse skin reaction; PPE; dermatitis; mask; glory; hand hygiene, disinfection; face shield; goggle; protect cloth. A total of 246 and 646 articles were retrieved from the two databases, respectively. 402 articles remained after removing duplicates. Reviews, non-English articles, articles that could not be accessed to read or did not conform to our topic were excluded. Finally, a total of 32 cross-sectional studies, 9 case reports and 2 randomized controlled trials were included.

Discussion

This article reviews reports of CD caused by various prevention and hygiene measures during the COVID-19 pandemic. The amount of skin damage caused by COVID-19 prevention measures could be decreased by improved education about skin management.

Implementation of the Hand Hygiene Eczema Education Program to Improve Patient Knowledge and Symptoms

Background: COVID-19 hand hygiene recommendation had resulted in a hand eczema -exacerbation. The guidelines of care for the management of hand eczema recommend the use of educational interventions for patients. Objective: An educational intervention was designed to increase the patient's knowledge of appropriate hand hygiene and improve the patient's symptoms. Methods: The validated self-assessment patient-oriented eczema measure tool and pre- and post-tests were used to measure outcomes prior to educational intervention and again in 1-2 months postintervention. Of the 26 participants enrolled, 21 completed the study. The study included newly diagnosed or established patients with eczema, and the education material was available for all patients. Results: The difference between the average pretest and initial posttest was statistically significant (df = 20, P (T ≤ t) = 0.000663535, p < .05). Similarly, the difference between the average pretest and follow-up posttest was also statistically significant (df = 20, P (T ≤ t) < 0.001, p < .05). Participants also had a 2.04 mean point decrease in symptoms severity. Conclusions: The results demonstrated an improvement in patient's knowledge and reduction in symptoms. Implications for Nursing: The program can serve as a new guideline for managing hand eczema symptoms due to COVID-19 in the adult population in the private office setting.

Soap or alcohol-based products? The effect of hand hygiene on skin characteristics during the COVID-19 pandemic

BACKGROUND

Different strategies for hand skin hygiene have been used to prevent the spread of SARS-CoV-2. However, frequent hand sanitization has been associated with skin damage. The present study aimed to evaluate hand hygiene habits during the COVID-19 pandemic and the effect of the repetitive use of soap or alcohol-based products on skin characteristics.

METHODS

We conducted a survey regards hand hygiene habits acquired during the COVID-19 pandemic. Also, we performed cutometry in a cohort of individuals who cleansed their volar forearms every 30 min, during 4 h, using soap or alcohol-based products.

RESULTS

We received 138 responses from people with medium-high educational level who reported a 2.5-time increase in the frequency of hand cleansing (p < 0.0001) that resulted in skin damage. An in vivo analysis of skin moisture and elasticity was also performed among 19 health workers and students. In general, skin moisture decreased with every cleansing, mainly after 2 h of washing with soap (p < 0.01), while skin elasticity only reduced after 4 h of treatment (p < 0.05). Alcohol-based solution or alcohol-based gel (70% ethanol, both) did not affect skin moisture or elasticity during testing.

CONCLUSION

It is known that the excessive use of soap or alcohol-based products causes dermatological issues. The present study demonstrates that non-medicated soap significantly affects skin moisture and elasticity, probably because the soap removes the hydrolipidic protective barrier, favoring transepidermal water loss, where the lack of the appropriate stratum corneum hydration also affects skin elasticity, mainly associated with changes in epidermal structure.

Pattern changes of cutaneous dermatoses among Iraqi women preceding and during the COVID-19 pandemic

Background: We compared the pattern of cutaneous dermatoses among Iraqi females of all ages between 4 months preceding the coronavirus disease 2019 (COVID-19) pandemic, and the same months 1 year later within the COVID-19 pandemic. Methods: This was a cross-sectional study, that targeted all female patients attending an outpatient clinic for dermatology and venereology in Al-Kindy teaching hospital, Baghdad between October 2019 to the end of January 2020, and the same 4-month duration 1 year later (October 2020 to the end of January 2021) after the COVID-19 peak period had passed and there was no or partial curfew to exclude seasonal impact. Results: A total of 2657 female-patients of all ages were enrolled in this study with 1314 females during the 4 months pre COVID-19, and 1343 females during the pandemic. The mean age of patients presented before the pandemic was 27.2±16.6 years, while the mean age of patients during the pandemic was 28.1±15.6 years with no statistically significant difference in mean ages (P >0.05). Hair loss in general with telogen effluvium specifically increased significantly. Cutaneous contagious viral infections were reduced significantly and specifically of these molluscum contagiosum and condylomata accuminata. Other forms of infections including bacterial and parasitic were also reduced while dermatophytosis was increased but not to a significant level. Acne vulgaris, rosacea, lichen planus, urticaria, pityriasis rosea, seborrheic dermatitis, and vitiligo were increased, but psoriasis, alopecia areata, other types of dermatitis, and melasma were reduced but none to a significant level. Conclusions: The COVID-19 pandemic resulted in changes in the pattern of diseases presented to an out-patient clinic for dermatology and venereology. This could be either related to COVID-19 infection or stress associated with the pandemic, because of curfew, or wearing facemasks which may cause a decrease or increase in certain diseases.

A hand-targeted auxiliary personal protective equipment for intervention of fomite transmission of viruses

In COVID-19, fomite transmission has been shown to be a major route for the spreading of the SARS-CoV-2 virus due to its ability to remain on surfaces for extended durations. Although glove wearing can mitigate the risk of viral transmission especially on high touch points, it is not prevalent due to concerns on diversion of frontline medical resources, cross-contamination, social stigma, as well as discomfort and skin reactions derived from prolonged wearing. In this study, we developed FlexiPalm, a hand-targeted auxiliary personal protective equipment (PPE) against fomite transmission of viruses. FlexiPalm is a unique palmar-side hand protector designed to be skin-conforming and transparent, fabricated from medical-grade polyurethane transparent film material as a base substrate. It serves primarily as a barrier to microbial contamination like conventional gloves, but with augmented comfort and inconspicuousness to encourage a higher public adoption rate. Compared to conventional glove materials, FlexiPalm demonstrated enhanced mechanical durability and breathability, comparable hydrophobicity, and displayed a minimal adsorption of SARS-CoV-2 spike protein and virus-like particles (VLP). Importantly, FlexiPalm was found to bind significantly less viral protein and VLP than artificial human skin, confirming its ability to reduce viral contamination. A pilot study involving participants completing activities of daily living showed a high level of comfort and task completion, illustrating the usability and functionality of FlexiPalm. Moreover, we have demonstrated that surface modification of FlexiPalm with microtextures enables further reduction in viral adsorption, thereby enhancing its functionality. An effective implementation of FlexiPalm will bolster PPE sustainability and lead to a paradigm shift in the global management of COVID-19 and other infectious diseases in general.

Personal protective equipment-related dermatoses in COVID-19 frontline health workers. A lesson learned from 1-year single center in the UAE

Since COVID‐19 was declared a pandemic in March 2020, frontline health care workers wear personal protective equipment (PPE, surgical masks, N95 or similar respirators, gloves, goggles, face shields, and gowns). Alcohol‐based sanitizers and wipes were recommended. Such measures lead to disruption of the natural skin habitat and skin barrier and various cutaneous reactions. The aim was to assess the prevalence and characteristics of PPE‐related dermatoses among health care workers in Sheikh Khalifa Medical City (SKMC), a COVID‐19 facility, Abu Dhabi, United Arab Emirates. We conducted a voluntary, cross‐sectional anonymous survey among first‐line health care workers addressing types of PPE used, dermatoses classified as PPE related, and factors that influence them. Facial, nasal, and hand dermatoses were the most prevalent with 40.2%, 19.9%, and 14.1%, respectively. The changes are primarily attributed to surgical masks, N‐95 masks, and gloves. The shift duration is a contributing factor correlating with the severity of skin damage. Results of this study encouraged decision makers to recognize PPE‐related dermatoses as a continuously growing burden, reorganized the shift duration and PPE exposure, animated the personal to apply preventive measures, and promoted the well‐being of medical professionals in new waves of the pandemic.

Indirect consequences of coronavirus disease 2019: Skin lesions caused by the frequent hand sanitation and use of personal protective equipment and strategies for their prevention

The coronavirus disease 2019 (COVID‐19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) enforced the use of hand sanitation and of personal protective equipment, such as masks and visors, especially by health‐care professionals, but also by the general public. However, frequent hand sanitation and the prolonged and continuous use of personal protective equipment are responsible for constant frictional and pressure forces on skin causing lesions, the most reported being acne, facial itching, dryness, and rash. Thus, it is important to find measures to prevent skin lesions, in order to improve the quality of life of health‐care professionals and of the general public. This article gathers the current information regarding measures to prevent human to human transmission of COVID‐19, reviews the most common skin lesions caused by the use of hand sanitizers and different types of personal protective equipment, and the possible preventive measures that can be used on a daily basis to minimize the risk of developing skin‐related pathologies. Daily skin care routines and the incorporation of a dressing between the skin and the personal protective equipment to serve as a protective barrier are some of the applied measures. Moisturizers and dressings improve the skin's ability to respond to constant aggressions. Lastly, the need for additional studies to evaluate the lubrication properties of different types of dressings is discussed. The understanding of what kind of dressing is more suitable to prevent pressure injuries is crucial to promote healthy skin and wellbeing during pandemic times.

Hand hygiene and hand eczema: a systematic review and meta-analysis

Hand eczema is a common inflammatory condition of the skin that has been linked to hand hygiene. This systematic review and meta-analysis aims to determine the risks of hand eczema associated with hand hygiene, including frequency of handwashing, wet-work and use of alcohol hand rub. A comprehensive search of MEDLINE, EMBASE and Cochrane Library was performed for cohort, case-control or cross-sectional studies that analysed the association between hand hygiene and risk of hand eczema. Results of individual studies were presented in respective forest plots and pooled summary relative risks were estimated using a random-effects model. Forty-five studies were included in analysis. Handwashing at least 8-10 times daily significantly increased risk of hand eczema (relative risk [RR] 1.51; 95% confidence interval [CI]: 1.35-1.68; P < .001). The risk was related to handwashing frequency, with higher pooled RR of 1.66 (95%CI: 1.51-1.83; P < .001) with increased handwashing at least 15-20 times daily. However, use of alcohol-based hand sanitizer was not significantly associated with risk of hand eczema. Given the widespread implementation of hand hygiene practices during the COVID-19 pandemic, there is a pertinent need to understand skin care habits specific to the hands to avoid a greater incidence of hand eczema. This article is protected by copyright. All rights reserved.

Teledermatology in the COVID-19 pandemic: a systematic review

Background

Teledermatology (TD) has emerged as a critical way of delivering care remotely in the COVID-19 pandemic.

Objective

We conducted a systematic review to assess how TD has been implemented worldwide.

Methods

We searched PubMed, Scopus, Embase, Web of Science, and Google Scholar for articles on the use of TD for patient care, written in English and published from December 1, 2019, to October 15, 2020.

Results

Twenty-seven studies were included, involving 16,981 patients. There was significant uptake of TD during the pandemic. Synchronous TD appeared to be more commonly implemented than asynchronous TD. Common ambulatory dermatoses such as acne or eczema were reported to be more amenable to TD assessment and management. TD also appeared to be useful for the diagnosis of cutaneous involvement of COVID-19 infection and follow-up of stable oncodermatology cases.

Limitations

A pooled analysis of all relevant outcomes was not always possible due to the heterogeneity in the methodologies of included studies.

Conclusion

TD is a useful and convenient tool for the management of common ambulatory dermatoses in the COVID-19 pandemic.

Skin adverse events related to personal protective equipment: a systematic review and meta-analysis

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a global pandemic that has spread all over the word. To avoid the virus transmission, healthcare workers must wear adequate personal protective equipment (PPE). PPE is associated with several side events, including skin reactions. The objective of this study was to summarize the prevalence, type and risk factors for cutaneous adverse events related to PPE and prevention measures to avoid them. A systematic review and meta-analysis was conducted using MEDLINE, Scopus and EMBASE databases from conception to 21 January 2021. All types of epidemiological studies regarding skin adverse events related to PPE were included. The literature search identified 1007 references, 35 of them met the eligible criteria and were included for analysis, representing 31 453 participants. The media of skin side events related to PPE was 75.13%. The rate of cutaneous adverse events related to mask was 57.71%, and those associated with gloves and hand hygiene products was 49.16%. Most common skin adverse events were contact dermatitis, acne and itching. The most damaged anatomical regions were the nasal bridge, the cheeks and the hands. The duration of PPE wearing was the most common risk factor. Frequent handwashing, gloves and masks were the agents most frequently related to skin reactions. N95 respirators were the most harmful mask type for the skin. Hydrocolloid use prevented from developing skin adverse events related to masks. In conclusion, the rate of cutaneous adverse events related to PPE use is high. A longer duration of PPE wearing was the most common risk factor. Using hydrocolloid could prevent from skin injuries related to mask use.