To stem the tide of COVID-19, the advice from all major health bodies is to wash your hands properly and frequently. However, regular hand washing can exacerbate skin conditions, such as eczema or psoriasis. In this feature, we ask the experts for advice.

Washing the hands regularly and thoroughly is one of the best ways to slow down the spread of SARS-CoV-2.

Starting in Wuhan, China, the novel coronavirus — now named SARS-CoV-2 — has reached every continent on earth except Antarctica.

Because the virus is new to science, researchers are still searching for ways to prevent, treat, or cure the disease.

Institutions, such as the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC), have set out their recommendations. At the forefront of these is thorough hand washing with alcohol-based hand gels or soap and water.

Skin conditions and hand washing
Hand washing is one of the most powerful ways to slow the spread of infectious diseases.

However, for individuals with particularly dry skin or skin conditions, such as eczema or psoriasis, excessive hand washing can result in skin damage and sore hands. Even for individuals with healthy skin, overuse of soaps and hand sanitizers can cause the skin to dry out and crack.

As Dr. Zainab Laftah, consultant dermatologist and a spokesperson for the British Skin Foundation explained to Medical News Today:

“Repetitive use of hand sanitizers and hand washing can strip the proteins in the epidermis (top skin layer), leading to a compromise of the skin barrier and, therefore, the risk of infection. Additionally, soaps can give rise to irritant hand dermatitis, which presents as dry, flaky, itchy red skin, particularly in the finger web spaces and on the knuckles.”

To avoid this, Dr. Laftah recommends “the use of a regular moisturizer.”

Individuals with preexisting skin conditions are more at risk of skin damage. These people “may benefit from hand washing with a moisturizer that contains an antibacterial ingredient, for example, chlorhexidine or benzalkonium chloride,” explains Dr. Laftah.

However, she notes that a recent study reported that “hand sanitizers containing these biocidal ingredients were less effective than alcohol-based hand gels at eradicating the coronavirus.”

Besides moisturizing, it is also important to dry hands thoroughly. This is important for two reasons: firstly, germs are transferred more easily between wet hands.

Secondly, as Dr. Laftah explains, “water itself has a drying effect on the skin by reducing the skin’s natural oils when it evaporates, thus impairing the skin barrier.”

Overall, Dr. Laftah recommends either of the following two options:

Wash with soap or with moisturizer and water, then moisturize.
Use an alcohol-based hand gel and then moisturize afterward. Moisturizing at the same time might compromise the anti-microbial properties of the hand gel.
She adds that a “moisturizer that lathers can act as a soap substitute and will be less drying on the hands; therefore, those with cracked skin may find this more soothing.”

Following on from this, Dr. Adil Sheraz, also a consultant dermatologist and a spokesperson for the British Skin Foundation, explained to MNT, “If patients feel the need to use alcohol or sanitizing gel, (this may exacerbate the eczema or skin condition), then apply emollient immediately afterward to minimize skin irritation.”

Minimizing the impact of hand washing
We contacted the British Association of Dermatologists who were keen to stress that they “don’t want to deter people from following government guidance on reducing the risk of coronavirus infection, hand washing being a key part of this.”

However, they do offer the following advice to help minimize the impact that increased hand washing might have on already damaged skin:

Moisturizers, or emollients, are vital for treating hand dermatitis. They help repair damaged outer skin and lock moisture inside. People should apply them repeatedly throughout the day, and whenever the skin feels dry.
Applying an emollient after washing the hands can help. They advise that some individuals might benefit from applying emollient to their hands overnight while wearing cotton gloves.
When washing the dishes, using cleaning products, or shampooing a child’s hair, a person can protect their hands by wearing latex or rubber gloves.
Immunosuppressants
Some skin conditions have an immune component. For this reason, doctors sometimes prescribe immunosuppressants, including methotrexate and ciclosporin.

Some individuals have shown concern and are asking whether they should stop taking their medication.

According to Dr. Sheraz, “There is no good evidence that being on immune-suppression necessarily increases the risk of getting COVID-19 or that the disease has a more severe course in such people. However, there is still a lot to learn about the virus, and following government advice is vital.”

The British Association of Dermatologists reiterate this stance. They make it clear that “creams used for skin conditions, in the correct quantities recommended by dermatologists or [doctors], are not likely to increase the risks of getting COVID-19 or having a more severe form of the illness.”

They write that “At present, most people are choosing to continue treatment until there is evidence on which to base advice. […] Any decision made about stopping treatment should include the consideration that your skin condition may deteriorate. It may also be more difficult to access healthcare services over the upcoming months.”

“Unfortunately there is no blanket answer for these patients,” Dr. Sheraz told MNT, “a decision will need to be made on a case to case basis. Stopping immune-suppressing medication may well result in a flare-up of the underlying condition. This will need to be taken into account.”

The overarching themes are that hand washing is essential and that individuals who have particularly dry hands or skin conditions should use emollients to minimize damage and consider buying emollient soap substitutes.