Eczema affects 1 in 10 Adults

Eczema is a very common skin disorder affecting children and adults. It affects 20% of children in the UK at some point in life, and 1 in 10 adults suffer from atopic dermatitis. Eczema is characterised by dry, scaly skin and mild to severe itching. It can be made worse by Western culture, rising pollution, and increasing stress levels.

COVID-19 (Corona Virus Disease 2019), and is classified as a respiratory illness caused by virus strain SARS-COV-2 (severe acute respiratory syndrome coronavirus 2), and as of yet, there is no vaccine.As of writing, there have been over 36 million reported cases and 1 million deaths globally (you can keep up to date with the current figures here).

Stress is a risk factor of eczema

COVID-19 has impacted our lifestyles. With people staying at home, our diet, health, fitness levels, mental state, and what we are exposed to in our environments daily have changed. For some people, stress levels have increased – due to changes in employment, worry over the virus, and uncertainty of the future – which is a risk factor of eczema.

According to an article in Nutrients – Dietary Choices and Habits during COVID-19 Lockdown: Experience from Poland – during the lockdown, people put down fruit and vegetables and picked up red meat, dairy, and fast food. Alcohol consumption and smoking also increased.
An imbalanced, unhealthy diet and lack of exercise can make eczema worse. With people consuming more saturated fats and refined carbohydrates or exposing their skin to more cigarette smoke during the lockdown, it would be hard not to link an increase in eczema to COVID-19.

How to wash your hands

Amy Paller, MD (chair of the department of dermatology at Northwestern University Feinberg School of Medicine and pediatric dermatologist at the Ann and Robert H Lurie Children’s Hospital of Chicago) recommends that people with eczema:

• wash their hands with warm water for at least 20 seconds, including tops and palms of the hands, wrists and between the fingers
• avoid hot water – using hot water makes no difference and can in fact trigger aggravate eczema
• after washing, ensure they rinse well, pat hands dry and apply moisturiser

Dr Paller says warm water is okay to use, particularly because hot water can aggravate eczema. After washing and rinsing well, the hands should be patted dry and a good moisturiser applied.
Hand eczema is caused by irritant contact dermatitis (which itself is caused by exposure to chemicals), atopic dermatitis (immune system), and dyshidrotic eczema. With the current COVID-19 pandemic putting the focus on hand hygiene (frequent washing and use of sanitizer), the role it plays in the lives of those who have eczema is notable. According to Dr Paller, constant hand washing will cause skin to dry out, causing an eczema flare-up because of the natural oils stripped from the skin.

Disrupting the skin barrier prevents your hands from locking in moisture

Currently, health authorities are advising the use of preventative measures leading to the overexposure of the hands to soaps, hand sanitizer, and disposable gloves – these are pre-existing risk factors of eczema. When used, they may disrupt the skin barrier, causing redness, itchiness, and flakiness due to dryness, and this prevents the skin from being able to lock in moisture.

The professions people are in can also be risk factors of developing hand eczema – for example, healthcare, nursing, cleaning, and industrial work. Increased exposure to sanitiser and hand washes have led to increased incidence of hand eczema. Fear of catching the virus has led to excessive hand washing.

Health and government officials are urging us to wash our hands frequently for up to twenty seconds, and even during lockdown when most people remained indoors, frequent hand washing continued for several weeks while the incidence of the virus was very high. Now that more businesses have reopened, hand washing and regular sanitising is the norm. While this may prove helpful in limiting the person-to-person transmission of COVID-19, it is not very good for the skin.

COVID-19 poses a significant risk for eczema sufferers

A group of researchers in India surveyed 16 people via phone between March 24th – April 5th, 2020, and found that they had developed hand eczema for the first time. While none of these people did work in healthcare, they had been excessively washing hands and using sanitiser in line with the WHO and national government recommendations. The symptoms developed were: itching, burning, dryness. Some patients’ hands showed redness of skin (erythema), scaling, and vesiculation (blistering).
The researchers discovered the first sign of eczema was often in the webs of the fingers and palms, which are areas where hand sanitiser may build up if not rubbed in properly.

While many people suffer from hand eczema daily, the presence of COVID-19 in society poses a significant risk. The issue people with eczema face is that the disrupted skin barrier may become a route of entry for COVID-19 due to large amounts of the cell receptor for SARS-Cov2 located in the blood vessels of the skin. To prevent this, people should allow hand sanitiser to dry and then use a hypoallergenic hand cream or emollient – this ideally will stop the hand sanitiser from being trapped in the webs of the fingers.

Other measures include not washing hands before or after the use of sanitiser. When hands are damp, the soap becomes more permeable (and is more likely to be absorbed by the skin) and disrupts the skin barrier causing the likelihood of eczema to increase.

Although frequent handwashing is important, the general public should be made aware of proper hand hygiene and the drawbacks of excess handwashing. The authors of an article in Dermatologic Therapy – ‘Hand eczema—A growing dermatological concern during the COVID‐19 pandemic and possible treatments’ – believe the prevention of hand eczema should be promoted through the use of moisturisers, barrier creams and providing education on skin protection.

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Blicharz, L., Czuwara, J., Samochocki, Z., Goldust, M., Chrostowska, S., Olszewska, M. and Rudnicka, L. (2020). Hand eczema—A growing dermatological concern during the COVID ‐19 pandemic and possible treatments. Dermatologic Therapy.

Foundation, B.S. (n.d.). Eczema – British Skin Foundation. [online] knowyourskin.britishskinfoundation.org.uk. Available at: https://knowyourskin.britishskinfoundation.org.uk/condition/eczema/ [Accessed 9 Oct. 2020].

Giacalone, S., Bortoluzzi, P. and Nazzaro, G. (2020). The fear of COVID ‐19 infection is the main cause of the new diagnoses of hand eczema: Report from the frontline in Milan. Dermatologic Therapy, 33(4).

Jones, K. (2020). Ask the Ecz-perts: Coronavirus (COVID-19). [online] National Eczema Association. Available at: https://nationaleczema.org/ate-covid-19/ [Accessed 9 Oct. 2020].

Patruno, C., Nisticò, S.P., Fabbrocini, G. and Napolitano, M. (2020). COVID-19, quarantine, and atopic dermatitis. Medical Hypotheses, 143, p.109852.

Singh, M., Pawar, M., Bothra, A. and Choudhary, N. (2020). Overzealous hand hygiene during COVID 19 pandemic causing increased incidence of hand eczema among general population. Journal of the American Academy of Dermatology.

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