Hand hygiene wreaks havoc on healthcare workers with atopic dermatitis

September 16, 2021

2 minutes to read


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According to a study published in Annals of Allergy, Asthma and Immunology.

Studies have shown that alcohols in hand sanitizers and detergents in soaps – the use of which has increased during the COVID-19 pandemic – decrease natural hydration factor and increase transepidermal water loss (TEWL). Additionally, healthcare workers already have an increased risk of irritant contact dermatitis, and increased hand hygiene can cause more symptoms in people with atopic dermatitis (AD) and other skin barrier dysfunctions.

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To better describe the impact of increased hand hygiene during the pandemic on healthcare workers and people with AD, Jessica Hui-Beckman, MD, and colleagues at National Jewish Health in Denver, distributed questionnaires on allergy history, hand hygiene practices, and skin symptoms related to hand hygiene to 36 people aged 18 to 60 in their establishment, of which 17 were health workers in contact with patients.

Seventeen of the participants had a history of AD with mild skin severity – including eight healthcare workers – while 19 were non-atopic and had no history of allergy.

Most participants said they had experienced more dryness and hand irritation since the start of the pandemic. Healthcare workers reported using hand sanitizer an average of nine to 18 times a day, compared with two to three times a day among non-healthcare professionals in the study (P = 0.0085), but there was no difference in the use of soap and water.

For 7 days before the skin test, participants refrained from using topical medications on the dorsal surface of their hands. They also did not use any moisturizer in the previous 24 hours or take a bath on the day of the test.

Results of individual skin exams showed that participants with AD had more signs of xerosis, erythema, and lichenification. In addition, 10 of the people with AD and four without AD had abnormal skin signs.

The researchers measured participants’ skin barriers via TEWL, which the researchers called a useful tool for assessing the integrity of the skin barrier.

Initially, the area under the curve for TEWL was significantly higher in people with AD, including those who were and were not healthcare workers, than in non-atopic participants (P <.05).

Participants then used hand sanitizer and soap, after which the researchers measured TEWL on the dorsal surface of their hands before and after five strips of skin tape, to assess water loss.

TEWL AUC increased after use of hand sanitizer, with even larger increases after use of soap and water, for all groups. Healthcare workers with (P <.01) and without (P <0.05) AD had an increased TEWL AUC after using a hand sanitizer compared to non-healthcare professionals without AD, although the researchers noted that healthcare workers with AD appeared to experience the greatest soap impact of any group.

Researchers have noted that people with AD have less of the natural moisturizing factor, necessary for skin hydration, in the outer layers of their skin. Handwashing with soap and water removes these skin-healthy products, the researchers said, and clinicians should then be careful to counsel their patients on skin care after using hand sanitizers and soaps.

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