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Pandemic-related handwashing brings rise in eczema – skin experts

FILED - After a year of hygiene advice during the pandemic, dermatologists are sounding the alarm that constant hand washing with soap is leading to more eczema. Photo: Rolf Vennenbernd/dpa
FILED – After a year of hygiene advice during the pandemic, dermatologists are sounding the alarm that constant hand washing with soap is leading to more eczema. Photo: Rolf Vennenbernd/dpa

“Wash your hands” was among the earliest piece of advice handed out by governments at the start of the pandemic. A year after hygiene advice turned millions around the world into Lady Macbeths, routinely scrubbing their hands, dermatologists are noticing adverse affects.

(dpa) – Wet your hands with running water, lather them by rubbing them together with soap, scrub them thoroughly for 20 to 30 seconds, rinse them well under running water and then dry them.

Everyone should be familiar with proper handwashing after more than a year of the Covid-19 pandemic. Even posters in places such as restrooms remind people not to neglect hand hygiene. A downside of this diligence is a rise in hand eczema, dermatologists are saying. Eczema is a condition that makes your skin red and itchy.

“The intensified hand hygiene measures that have been recommended carry a considerable health risk for the occurrence of hand eczema,” says Peter Elsner, spokesman for the German Dermatological Society (DDG). He advises the use of hand sanitizer instead of soap.

Feedback from dermatologists’ surgeries and dermatology clinics shows that the number of patients with hand eczema has increased over the past year, Elsner notes. Healthcare workers are particularly at risk.

In a survey of 114 healthcare workers (39 physicians, 75 nurses) at Munich University Hospital, more than 90 per cent reported symptoms of acute hand eczema such as dryness, redness, itching, a burning sensation, scaling and cracked skin. Participants also reported a significant increase in handwashing, disinfection and the use of hand cream since the start of the pandemic, regardless of having direct contact with Covid-19 patients.

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“During the pandemic, it’s of course important to practice social distancing, wash your hands often, and wear a face mask,” says Elsner, “but hand sanitizer is better than soap for healthy skin.”

Soap removes natural oils and dries the skin, disrupting its function as a protective barrier against bacteria, irritants and allergens, he explains. So unless your hands are visibly dirty, the DDG’s pandemic guidelines recommend use of an antiviral, alcohol-based hand sanitizer instead of soap. They also advise moisturizing your hands with a cream, lotion or ointment after every time you wash or sanitize them.

The general public was urged to guard against the novel coronavirus by frequent and thorough handwashing with soap “for purely political reasons,” says Elsner, pointing out that there was a shortage of hand sanitizer at first, along with a shortage of face masks.

Germany’s Federal Centre for Health Education (BZgA) has no reservations about the use of soap, however. On its web pages it states that “many infectious diseases are transmitted via the hands … handwashing is a simple and effective measure that can protect you from infection” – which is especially important in times of an epidemic.

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“Washing your hands with soap is much more effective than with water alone, as cleansing agents remove dirt and microbes from the skin,” the BZgA goes on, adding that handwashing without soap is better than nothing, though, “because with water alone, at least some of the pathogens are removed.”

The BZgA concedes that soap attacks the skin’s barrier defence: “The skin can dry out, which can lead to skin irritation,” it says, and therefore recommends using mild, pH-neutral cleansing agents, and moisturizing your hands afterwards.

On the pros and cons of soap, a hygienist concurs with the dermatologists: “The less you wash your hands, the better it is for the skin – the dermatologists are right about this, of course,” says Christian Brandt, director of the Institute of Hygiene and Environmental Medicine at the Berlin-based Vivantes Network for Health, Germany’s largest municipal hospital concern.

“It’s logical and understandable that eczema cases increase,” he remarks. On the other hand, handwashing with water but no soap can rinse off dirt “but can’t remove pathogens from the skin.”

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The answer to this dilemma, in Brandt’s view, is not to wash your hands “excessively,” but only when it’s really necessary, for instance before eating, after using the toilet or if they’re very dirty from work.

Brandt agrees with Elsner that using hand sanitizer is better than soap. It’s “more efficient, faster and gentler to your skin,” he says. “In combating viruses, including the novel coronavirus, handwashing with soap is always inferior to the use of alcohol-based hand sanitizer,” which is why hand sanitizer is used in hospitals.

As for the population at large, hand sanitizer is “a good alternative when you’re out and about,” says Brandt.

But neither continual handwashing nor continual disinfecting with hand sanitizer is necessary to protect yourself from the coronavirus, he argues. Rather, when you’re outside the home, it’s important not to touch a lot of things, not to touch your face, and not to eat out of your hand, because the virus is transmitted through mucous membranes in the mouth, nose and eyes.

The skin itself isn’t a gateway for viruses, he notes.

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