Hand hygiene takes toll on health care workers with atopic dermatitis

Health care workers with atopic dermatitis had greater irritation, dryness and other skin issues due to how frequently they washed their hands, according to a study published in Annals of Allergy, Asthma & Immunology.

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

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

Seventeen of the participants had a history of AD with mild skin severity — which included eight of the health care workers — whereas 19 were nonatopic and had no allergy history.

Most of the participants reported experiencing more hand dryness and irritation since the onset of the pandemic. Health care workers reported using hand sanitizer an average of nine to 18 times a day, compared with two to three times a day among non-health care workers in the study (P = .0085), but there was no difference in soap and water use.

For 7 days prior to skin testing, the participants refrained from using topical medications on the dorsal surface of their hands. They also did not use moisturizers during the previous 24 hours or bathe on the day of testing.

Results of individual skin exams showed participants with AD had greater evidence of xerosis, erythema and lichenification. Also, 10 of those with AD and four without AD displayed abnormal skin findings.

Researchers measured the participants’ skin barriers via TEWL, which the researchers called a useful tool to evaluate skin barrier integrity.

At baseline, the area under the curve for TEWL was significantly higher among those with AD — including those who were and were not health care workers — than among the nonatopic participants (P < .05).

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

TEWL AUC increased after hand sanitizer use, with even greater increases after soap and water use, for all groups. Health care workers with (P < .01) and without (P < .05) AD had an increased TEWL AUC after hand sanitizer use compared with non-health care workers without AD, although researchers noted that health care workers with AD appeared to experience the greatest impact from soap of all the groups.

The researchers noted that individuals with AD have less natural moisturizing factor, which is needed for skin hydration, in the outer layers of their skin. Hand washing with soap and water removes these healthy skin products, the researchers said, and clinicians should then be mindful in counseling their patients about skin care after using hand sanitizers and soaps.