Hand Care in Time of COVID-19
Who hasn’t got sore, red, cracking, itchy hands? Frequent hand-washing for at least 20 seconds with soap and water, or use of alcohol hand gel, is the order of the day, resulting in an irritant contact dermatitis (ICD). Some of us are more prone to this than others, with underlying atopic dermatitis for example, but the increased contact with irritants, principally detergents, will affect all of us to some extent.
However, we must continue to wash our hands with soap and water or use alcohol hand gel, and manage the consequences as best we can. Using moisturisers as soap substitutes may not remove virus particles from hands as effectively as soap and water, so this strategy which is usually recommended to people with hand dermatitis* is best avoided for now.
So here’s how we can best look after our hands:
- 1. After washing for at least 20 seconds with soap and water, pat rather than rub the hands dry to minimize mechanical damage to the skin
- 2. Use a moisturiser regularly, after washing hands, whenever the skin feels dry and sore and at night.
- I’d suggest a cream during the day as the lighter formulation is more cosmetically acceptable
- Keep a tube handy at work, and a bigger dispenser at home if wished, and have your own rather than share with others
- A greasier ointment may be best used at night, under a pair of clean cotton gloves
There are many moisturisers available to purchase from supermarkets and chemists but the important thing is to find one you like and then use it! I’d suggest using a fragrance-free moisturiser as it is possible to have or develop an allergy to fragrances. **
3. Protect your hands when you can
- Wear nitrile gloves for washing up, shampooing hair, household cleaning, handling irritant foods such as citrus fruits and potatoes etc. Use the dishwasher where you can.
Despite all the above, if the dermatitis is severe or oozing, you may need treatment with a steroid ointment or cream, sometimes with an added antibiotic to settle the inflammation. 1% hydrocortisone is a mild topical steroid, and may be sufficient in some cases. It may be purchased from a pharmacy, and the pharmacist will be able to advise you. Any more potent (stronger) topical seroid will require a prescription. This is unlikely to require a face-to-face consultation.
Ointments are preferable, and greasier, and best applied at night.
Topical steroids should be used intermittently rather than continually; many people are concerned regarding “thinning of the skin”, and apply them too thinly or infrequently but if used as directed by your pharmacist or doctor they are safe to use. A good rule of thumb is that 1 finger tip unit (a line of cream or ointment squeezed from the furthest crease to tip of an adult index finger) is enough to treat a handprint-sized area.
When we return to more normal practice your hands should return to normal too. If not you may need further assessment and tests for a possible allergy, but that can wait for now.
So hang on in there, keep washing your hands, but hopefully these tips will mean they cope as best they can, as we all keep doing the best can.
Very helpful patient information leaflets on Hand dermatitis/hand eczema and How to care for your hands are available at http://www.bad.org.uk/
Article by Dr Fraser-Andrews
*dermatitis and eczema are different words for the same condition
**CAUTION: emollients, creams, lotions and ointments contain oils, which can catch fire if they are in contact with clothes, bed linen or hair and exposed to a naked flame or cigarette. Care is therefore required, especially in bed. Clothes and bed linen in contact with emollients or moisturisers should be washed regularly.