key: cord-270313-k0cj209s
authors: Erdem, Yasemin; Altunay, Ilknur Kivanc; Aksu Çerman, Aslı; Inal, Sena; Ugurer, Ece; Sivaz, Onur; Kaya, Hazel Ezgi; Gulsunay, Ilayda Esna; Sekerlisoy, Gul; Vural, Osman; Özkaya, Esen
title: The risk of hand eczema in healthcare workers during the COVID‐19 pandemic: Do we need specific attention or prevention strategies?
date: 2020-06-07
journal: Contact Dermatitis
DOI: 10.1111/cod.13632
sha: 
doc_id: 270313
cord_uid: k0cj209s

nan

China in late 2019. Apart from the respiratory droplets, contact transmission was announced to play an important role both in the spreading of the disease. Therefore, hand hygiene became an important building block for prevention; WHO has recommended using water and soap, or alcohol-based hand disinfectant before and after the contact with patients and/or their body fluid. 1 Independent from COVID 19, healthcare workers (HCW) have an increased risk for hand eczema (HE). 2.3 Skin damage due to intensive hand hygiene measures during the COVID-19 pandemic in HCW has recently been reported, 4, 5 as well as HE among HCW during the pandemic. 5 Therefore, we aimed to investigate the frequency, risk factors, and clinical features of HE among healthcare workers during the COVID-19 pandemic.

Between May 15 to 25, 2020, a total of 107 HCW involved in COVID-19 patient care units of our hospital were enrolled to the study. All individuals were examined by a team of dermatologists.

Demographic and clinical findings were filled in a detailed form. Hand Eczema Severity Index (HECSI) scoring system was used in the standardization of HE severity. 6

HE was detected in 54 of 107 (50.5%) participants. The overall demographic and clinical parameters, and the comparison of these parameters between groups with and without HE are summarized in Online supplemental Table 1a (Table 3) .

Moisturizing hand cream was used in 26 (57.8%) patients before, and in 36 (80%) patients after the development of HE. Topical corticosteroids were used only in 16 (35.6%) after HE has developed.

The frequency of handwashing and the use of alcohol-based disinfectants did not change before and after HE (Table 1b) .

The frequency of HE was 50.4% among healthcare workers at COVID-19 patient care units in this study. The HE prevalence in pre-COVID-19 era varied between 12%-50%. 2, 7 Lan et al reported a high share of 70.4% hand skin damage due to frequent hand hygiene and longer times of using gloves in healthcare workers managing COVID-19. 4 Recently, Guertler et al published a questionnaire-based study among healthcare workers at COVID-19 units. The vast majority of the study population (90.4%) reported symptoms associated with acute hand dermatitis whereas the prevalence of selfreported HE was only 14.9%. 5 Previous reports have demonstrated that personal or familial atopy, >20 handwashing per day, using occlusive gloves, and long working years are independent risk factors for HE. 3 On the other hand, HE frequency was lower in individuals using moisturizers, and the use of moisturizers has been recommended for preventing HE. 3, 8 The increased risk of HE with frequent handwashing >20 per day was in line with the literature from pre COVID-19 era. In contrast to the literature, however, the increased use of moisturizing hand cream was independently associated with HE in the present study.

This might suggest that patients with HE used moisturizing creams with a therapeutic intent after the development of HE, rather than for prevention. It was interesting that only 1/3 of patients used topical corticosteroids after the development of HE, and that a majority (80%) increased the frequency of moisturizer use instead. Although the use of moisturizers before HE development was reported as 57.8% among patients with HE, we cannot assume whether the moisturizs had been used appropriately.

The limitation of this study was its small sample size. However, the diagnosis of HE based on dermatological examination during COVID-19 pandemic was the strength of the study. In conclusion, because hand hygiene is one of the key factors to prevent COVID-19 transmission, preventive strategies are rapidly needed in order to reduce HE risk related to hand hygiene. This article is protected by copyright. All rights reserved.

Online supplemental Table 1a .94

Online supplemental History of hand eczema in the past year <.001 18. 5 3.82-89.9 

Prevalence of hand dermatitis in inpatient nurses at a United States hospital

Prevalence and risk factors of hand eczema in hospitalbased nurses in northern China

Skin damage among healthcare workers managing coronavirus disease-2019

Onset of occupational hand eczema among healtcare workers during the SARS-CoV-2 pandemic-comparing a single surgical site with a COVID-19 intensive care unit. Contact Dermatitis

The hand eczema severity index (HECSI): a scoring system for clinical assessment of hand eczema. A study of inter-and intraobserver reliability

Hand eczema among healthcare professionals in the Netherlands: prevalence, absenteeism, and presenteeism

Guidelines for diagnosis, prevention and treatment of hand eczema

Clinical characteristics of hand eczema ⁋ According to patient's history of a confirmed diagnosis by patch testing in the past HECSI: Hand eczema severity index §HECSI 0-11 points: mild eczema, 12-27 points: moderate eczema

Dyshidrotic/vesicular, n (%)

Erythema-squamatous, n (%)

Hyperkeratotic/rhagadiform, n (%) Combined morphology, n (%)

Localizations Palm, n (%)

Dorsum, n (%) Finger webs, n (%) Sides of finger, n (%)

Periungual eczema and nail eczema, n (%)