European Task Force on Contact Dermatitis statement on coronavirus disease‐19 (COVID‐19) outbreak and the risk of adverse cutaneous reactions

Abstract

Among the basic protective measures against COVID-19, the need to wash hands frequently and in a prolonged way using soap and to regularly use alcohol-based hand sanitizers is well established for the whole population. Healthcare workers in general, and particularly those involved in the direct care of COVID-19-infected patients, have to wear personal protective equipment (PPE) daily for many hours and also accomplish general preventive measurements outside their work. Cutaneous adverse reactions can develop that need to be prevented, identified and therapeutically managed. According to the data reported by Lin et al.,1 based on the experience from healthcare workers in Wuhan, adverse skin reactions were reported in 74% of responders (n = 376) to a general survey. The most commonly reported types of eruptions were skin dryness or desquamation (68.6%), papules or erythema (60.4%) and maceration (52.9%). Hands, cheeks and nasal bridge were the top three most commonly affected areas. Adverse skin reactions showed in the univariate analysis a significant association with sex, epidemic level, working place, duration of full-body PPE use, getting soaking wet after work and frequency of handwashing. The multivariate analysis showed an increased number of reactions in females, who work at the hospitals, in inpatient wards and use full-body PPE for over 6 h per day. Similar results were reported from Chengdu, with 198 of 404 (49.0%) respondents to an online survey from the healthcare sector reporting mask-related skin reactions, mostly, in 169, in the face following prolonged use of N95 and medical-grade masks. Of note, worsening of pre-existing facial skin problems such as acne or rosacea was frequently reported.2 This scenario is certainly similar to what the health care personnel is suffering nowadays in Europe.3 The identification of these cutaneous reactions, how to prevent and treat them is the objective of this document. Prevention and management of irritant and allergic contact dermatitis in relation to hand hygiene, hand personal protective devices and the use of face protection masks in the COVID-19 environment. During this pandemic, the mandatory protection regime against the viral infection aggravates the risk of developing severe hand dermatitis. Handwashing is essential to prevent COVID-19 infection and should be performed before and after each activity using soap without fragrance and preservatives without or a low sensitizing potential. There is also a recommendation to use hydro alcoholic solutions with glycerin. Alcohol-based hand solutions containing glycerin as moisturizer were studied intensively and are recommended to replace traditional soaps for handwashing within healthcare facilities.4, 5 Although these solutions are better tolerated than standard detergents,5, 6 the additional regular use of a fragrance-free7 emollient after these procedures greatly improves its acceptance, as already stated by Wollenberg et al.8 It is recommendable to protect the hands with a fragrance-free, lighter moisturizing lotion during the day after each handwashing procedure and a fragrance-free, lipid-rich moisturizer before bedtime. True allergic reactions to alcohol-based formulations are very rare.9 In most situations, a double set of gloves is used for prolonged periods and accurate hygiene of such gloves with hydro alcoholic solutions are required. In order to minimize sweating and skin irritation, cotton gloves should be worn underneath as liners. Irritant or mechanical/friction dermatitis due to the use of masks and protective glasses is frequent among healthcare personnel. The use of dressings at pressure points on the face and ears to prevent rubbing against masks and goggles, such as hydrocolloid dressings, or the fixation of these dressings with dimethicone polymers or silicone gels could minimize the risk of adverse cutaneous reactions from mechanical friction. Promoting education on proper use of PPE and restriction on the duration of wearing could avoid some cutaneous adverse events. Correct hand hygiene, adequate glove use, as well as hand and facial care are recommended in the general population and particularly among healthcare personnel; the care of occupational physicians and occupational dermatologists can contribute to the prevention and treatment of more severe cases.

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