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Eczema and Hand Hygiene Care

With Dr Lynn Chiam, Consultant Dermatologist @ Children & Adult Skin

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The ongoing Covid-19 pandemic has made frequent handwashing a necessity, with global health institutions like the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) recommending thorough hand washing with soap and water, or alcohol-based hand sanitizers.

As a consequence, many people now experience dry, irritated skin on their hands, a condition known as contact dermatitis, otherwise known as hand eczema. Those who already struggle with eczema or dry, sensitive skin are affected more severely.

Eczema is a recurrent skin condition where the skin is dry, easily irritated, intensely itchy and inflamed because the skin barrier is weakened.i

To use a simple analogy, imagine the skin’s structure as a brick wall – the individual bricks are skin cells, and the mortar holding the bricks together are lipids. When the lipids are continuously being washed away, the mortar becomes weak. This allows moisture to escape, leading to dry skin, and allows irritants to penetrate, causing irritation, inflammation and itching.ii

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Skin that is prone to eczema contains less ceramide than normal skiniii, and frequent hand-washing can make it worse. Even people with normal skin may experience this problem on their hands, especially those who are involved in healthcare, hygiene or food services which have stringent guidelines.iv

This has a dual effect on the skin’s protective barrier: soap is alkaline, which raises the skin’s pH level from its normal acidic state, and removes its natural lipids.v vi viiAs a result, the skin produces less ceramide and the natural skin barrier is less effective against allergens and bacteria.iii viii ix

Common signs or symptoms of hand eczema are itching, redness and dryness. In severe cases, the skin may become so dry that it peels and flakes, or cracks.x When in doubt, do consider visiting your GP or specialist for further evaluation. Early intervention will help to reduce the severity and accelerate the recovery.

Hand eczema can be divided into irritant contact dermatitis, which is caused by exposure to a substance that causes irritation such as harsh soaps, new cosmetic products and allergic contact dermatitis, which is caused by a delayed immune reaction.xi

It’s important to use products that respect the skin’s natural acidic state, skin barrier functions and lipid content.xii

Moisturisers and emollients with a ceramide-dominant formula can help to replenish ceramides in the skin. This in turn supports and helps to repair the skin barrier, making it more resilient against moisture loss and irritants.xiii

It’s essential to continue taking all the necessary precautions to protect yourself and others around you, which includes washing or sanitising your hands regularly. If you have sensitive skin, use a gentle soap instead of harsh anti- bacterial soap. If washing with soap and water leaves your hands feeling dry and irritated, studies have shown that alcohol-based hand sanitisers are better tolerated compared to soap or detergent-based cleansers. The CDC also recommends the use of alcohol-based hand sanitisers that contain moisturising agents.xiv xv

Consider using a hand sanitiser that contains emollient like ceramide-dominant formula that helps to replenish essential lipids and is pH-balanced and buffered to remain stable at pH5.5, to protect the skin’s natural acidic barrier.xvi

For further protection, experts also recommended that you apply a moisturiser regularly throughout the day, especially after washing or sanitising your hands.xvii

As an alternative, a soap-free (synthetic detergent) wash or cleanser that contains ceramide-dominant formulation is designed to cleanse the skin without damaging its protective barrier. It should have a stable pH 5.5. and is also free-from common irritants such as fragrance and colouring, making it suitable to all age groups and skin types, including those with eczema or dry, itchy skin. xviii

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Consultant Dermatologist
Children & Adult Skin Hair Laser Clinic at Mount Elizabeth Novena Specialist Medical Centre
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References:

  1. Skin Conditions and Eczema, WebMD, https://www.webmd.com/skin-problems-and-treatments/guide/atopic-dermatitis-eczema#1
  2. Kim BE, Leung DYM. Significance of Skin Barrier Dysfunction in Atopic Dermatitis. Allergy Asthma Immunol Res. 2018;10(3):207–215. doi:10.4168/aair.2018.10.3.207, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5911439/
  3. Del Rosso J, et al. “Understanding the Epidermal Barrier in Healthy and Compromised Skin: Clinically Relevant Information for the Dermatology Practitioner” J Clin Aesthet Dermatol 2016;9(4 Suppl 1): S2-S8
  4. Today. Skin problems from frequent washing, sanitising of hands ‘unavoidable reality’ during Covid-19, https://www.todayonline.com/singapore/skin-problems-frequent-washing-sanitising-hands-unavoidable-reality-during-covid-19
  5. Panther DJ, et al. “The Importance of Acidification in Atopic Eczema: An Underexplored Avenue for Treatment” J Clin Med 2015;5:970-978
  6. Surber C, et al. “The Acid Mantle: A Myth or an Essential Part of Skin Health?” Curr Probl Dermatol 2018;54:1-10.
  7. Lambers H, et al. “Natural skin surface pH Is on average below 5, which is beneficial for its resident flora” Int J Cosmet Sci 2006;28:359-370.
  8. M Ali S and Yosipovitch G. “Skin pH: From Basic Science to Basic Skin Care”. Acta Derm Venereol 2013; 93: 261–267.
  9. Stadler J-F, et al. “The emerging role of skin microbiome in atopic dermatitis and its clinical implication” Journal of Dermatological Treatment 2019;30(4):357-364.
  10. National Eczema Association. Hand Eczema, https://nationaleczema.org/eczema/types-of-eczema/hand-eczema/
  11. Usatine RP, Riojas M. Diagnosis and management of contact dermatitis. Am Fam Physician. 2010 Aug 1;82(3):249-55. PMID: 20672788. https://pubmed.ncbi.nlm.nih.gov/20672788/
  12. Ananthapadmanabhan KP, Leyden JJ, and Hawkins SS. Recent Advances in Mild and Moisturizing Cleansers. Journal of Drugs in Dermatology, January 2019, Vol 18 (1), S80-89.
  13. Vávrová K., Kováčik A., Opálka L., “Ceramides in the skin barrier”, Eur. Pharm. J. 2017, 64 (2): 28-35. ISSN 1338-6786 (online) and ISSN 2453-6725 (print version), DOI: 10.1515/afpuc-2017-0004
  14. Rundle CW et al. “Hand hygiene during COVID-19: Recommendations from the American Contact Dermatitis Society”. Published online July 22, 2020 by the American Academy of Dermatology, Inc. https://doi.org/10.1016/j.jaad.2020.07.057
  15. Araghi et al. Hand Hygiene Among Health Care Workers During COVID-19 Pandemic: Challenges and Recommendations. DERMATITIS, Vol 31 • No 4 • July/August, 2020
  16. Ceradan® Hand Lotion Sanitiser, https://www.ceradan.com/product/ceradan-hand-lotion-sanitiser/
  17. Beiu C, Mihai M, Popa L, et al. (April 02, 2020) Frequent Hand Washing for COVID-19 Prevention Can Cause Hand Dermatitis: Management Tips. Cureus 12(4): e7506. DOI 10.7759/cureus.7506
  18. Ceradan® Moisturising Body Wash, https://www.ceradan.com/product/ceradan-moisturising-body-wash/