COVID-19 Preventive Measures Driving Increase in Contact Dermatitis, Says Study

Throughout the COVID-19 pandemic, the prevalence of various skin conditions has increased as a result of preventive measures to combat the spread of the virus, according to new study findings.

The cause of the increase is 2-fold: an increased push for personal hygiene practices and the use of personal protective equipment (PPE) for health care workers (HCWs).

“PPE includes surgical masks, N95 respirators, goggles, caps, gloves, and fluid-resistant gowns, all of which could be responsible for hyperhydration, friction, epidermal barrier breakdown, and contact reactions, leading to allergic [ACD] or irritant contact dermatitis [CD],” wrote the researchers in Current Treatment Options in Allergy. “Of note, erythema, papules, maceration, and scaling have been the most commonly reported skin lesions caused by extended wear of PPE among 97% of HCWs. Clinical manifestations include burning, itching, and stinging. Furthermore, the risk of developing skin damage increase when PPE is worn for more than 6 hours.”

Commonly used among HCWs, gloves have been associated with a 2.68-times greater risk of xerosis and eczema on the hands. According to the researchers, CD associated with PPE, like gloves, can be traced to the composition of the materials; for example, rubber gloves accelerators used to manufacture nitrile gloves, including thiurams, carbamates, and diphenylguanidine.

This is also the case for facial PPE, say the researchers. The textiles dye mix used in surgical or cloth masks, as well as contact allergans such as polyurethanes and formaldehyde-releasing preservatives, have been reported to cause acute CD.

In a sample of 43 HCWs treating patients with COVID-19, irritant CD (ICD) was the most commonly reported (39.5%) skin condition. Nearly two-thirds (63%) of the HCWs reported ICD on the nasal bridge, and one-fourth (26%) reported ICD on the cheeks and chin. The researchers cited another survey that compared the prevalence of skin reactions based on mask type among 1200 people, finding that skin reactions, including ICD, were more likely in those wearing surgical masks or N95 respirators compared with cloth masks.

Recommendations for preventing and managing CD during the pandemic include using thin-film dressings, thin hydrocolloid dressings, and barrier products made of acrylate, silicon, or dimethicone on pressure or irritated areas such as the nasal bridge, cheeks, and ears.

Outside of the health care setting, frequent handwashing and disinfecting of surfaces has been heavily encouraged among the entire general public. In one study, it was suggested that hand washing during the pandemic has increased the risk of xerosis and eczema by 3.57 times.

“Soaps and detergents contain fragrances, surfactants, and preservatives that are potential contact allergens leading to ACD. ABHS has been implicated in causing skin dryness and subsequent ICD,” explained the researchers. “Moreover, alcohol-based hand sanitizers [ABHS] often contain ingredients, such as fragrances, tocopherol, propylene glycol, benzoates, and cetylstearyl alcohol, that can also cause ACD. Most disinfectants and disinfectant wipes can be regarded as potential skin irritants and/or sensitizers, considering their compounds, including citric acid, ethyl alcohol, hydrogen peroxide, quaternary ammonium, or sodium hypochlorite.”

Published recommendations for preventing and managing CD suggest using ABHS that contain at least 60% ethanol or 70% isopropyl alcohol and glycerin as moisturizer.

Reference

Babino G, Argenziano G, Balato A. Impact in contact dermatitis during and after SARS-COV2 pandemic. Curr Treat Options Allergy. Published online February 10, 2022. doi:10.1007/s40521-022-00298-2