COVID-19, handwashing and the skin
This article has been updated on 14th April 2020 following questions from colleagues so I have added additional material which has become available since this was first published.
With the current situation and the Covid-19 epidemic, handwashing has never been more important to prevent the spread of the virus along with social distancing where possible. The government has issued detailed guidance on how to wash your hands in a video and pictures. Washing of the hands thoroughly, causes any fragile viral particles to disintegrate and be physically removed from the skin reducing the risk of spreading the infection.
As healthcare professionals, we all know what the effects of excessive handwashing can be, particularly for those with pre-existing skin conditions such as eczema. Excessive washing and drying of hands or use of alcohol-based hand sanitisers can lead to the development of irritant contact dermatitis causing the hands to become cracked, itchy, sore or red. The British Association of Dermatologists has issued some guidance on handwashing set out below
• Wash hands in line with government guidance, using soap and water. This can be difficult for people with dry and cracked skin, but the British Association of Dermatologists advise to follow the government guidance as much as is practical.
The use of soap has been shown to penetrate the delicate fat coating around the coronavirus and so destroy or remove it from the skin but emollients and soap substitutes don't do this so there is a theoretical risk it might trap or somehow protect the virus (but this is untested). On that basis soap and water washing for 20 seconds remains the advice.
• Dry your hands fully after washing by patting them dry, not rubbing.
• When the hands are going to come into contact with water or detergents, but when not specifically washing the hands, wearing gloves that provide a barrier (such as nitrile gloves) will help to keep the skin’s barrier intact.
BUT the key is to remember to moisturise! Moisturisers (emollients) are an essential part of treating hand dermatitis. They help repair the damaged outer skin and lock moisture inside the skin making it soft and supple again. They should be applied generously after handwashing and drying, repeatedly through the day, and whenever the skin feels dry.
• Some people find overnight moisturising treatments beneficial. Apply a generous layer of a plain moisturiser just before you go to bed, then put on a pair of clean cotton gloves and leave overnight.
· Finally, as the infection gains entry to the body through the nose, mouth and eyes, avoid touching your face unless your hands are thoroughly clean.
Professor Hywel Williams, a dermatologist has produce a short video discussing the issue of handwashing for those with dry skin or eczema offering advice on how good skin care can be achieved even with frequent washing at this time:
This advice is collated from a range of trusted sources based on the knowledge available at the time of publication – links are provided within the text for further clarification.