Handwashing/Irritated Skin Article IPN

Proper handwashing is one of the best ways to prevent spreading viruses, like the coronavirus (COVID-19) and the flu. However, as we all take measures to curb the spread of COVID-19, there has been a dramatic increase in patients presenting to us in pharmacies seeking treatment for dry skin on their hands.

Frequent handwashing and the use of alcohol sanitisers strip the skin of moisture and leave it dry, sore and red. In more severe cases, fissures can develop where the skin has cracked. This condition is known as irritant contact dermatitis and is a form of eczema.

So how can we protect our skin while protecting ourselves from the coronavirus?

Emollients are a well known and effective treatment for dry skin conditions, including irritant contact dermatitis. When applied correctly they play a vital role in re-establishing healthy, intact skin. Providing advice on the correct treatment and helping patients filter through the large selection of over-the-counter emollients is becoming an even more important role for pharmacy teams.

Firstly, lets have a quick look at the structure of our skin – the body largest organ. It is a protective barrier against pathogens and helps to maintain body temperature. The skin is made up of three layers:

1. Epidermis (the outermost layer)

2. Dermis (the middle layer of the skin) This layer provides a variety of functions including sweat regulation and oil production. It is the location of the hair follicles, blood vessels and nerve endings.

3. Subcutaneous fat layer – this fat layer helps to regulate body temperature and connects the dermis to the muscles and bones.

The cumulative effect of constant handwashing and chronic exposure to irritants like alcohol can disrupt the stratum corneum in our epidermis and allow penetration of irritants into the deeper layers of the skin. Immune reactions can result leading to inflammation, and increased water loss from the skin leads to dryness, itching and cracking. Unfortunately, people prone to existing skin conditions such as eczema are even more likely to develop irritant dermatitis. It is even more important for them to be gentle with their hands after washing.

Moisturisers or emollients really are the mainstay in the treatment of contact irritant dermatitis. They contain a variety of ingredients that form an oily layer on the surface of the skin. This prevents water loss from your skin, keeping it hydrated. Furthermore, histamine release is reduced and lipid synthesis is stimulated helping to reduce inflammation. There are a number of emollient formulations including creams, lotions, soap substitutes and ointments. There is no ‘best’ emollient – response can differ greatly from patient to patient. In general, oil-based products tend to be more effective at replenishing the skin’s moisture but are less popular due to the lasting greasy residues on the patient’s skin. Often a combination of products are used where a ‘lighter’ product can be applied during the day and a thicker, more moisturising product applied at night.

There are many different emollient formulations available, each containing a number of different ingredients.

Types of emollients:

1. Lotions are an emulsion of oil in water. Lotions contain more water than oil so are less moisturising than creams. They spread easily and so are useful for hairy areas or when quick absorption is required. Examples include E45 lotion and Aveeno lotion.
2. Creams – another emulsion of water and oil with a higher oil content than lotions. These are thicker and more moisturising than lotions. They are not greasy and are suitable for daytime use. Examples include Relife Relizema cream, E45 cream, Neutrogena hand cream, Aveeno cream, Diprobase cream and Oilatum cream.
3. Ointments – often a cosmetically unacceptable product for most as these are stiff and greasy, although they provide an excellent barrier on the skin to prevent water loss and so aid skin barrier repair. They are particularly useful for dry, thick, scaly areas. Patients may consider using these at night. Examples include Diprobase ointment, Epaderm ointment.
4. Soap substitutes – An alternative to traditional soaps, these are effective at cleansing while helping to prevent further drying of the skin and reducing itching. They do not elevate the skin’s pH as traditional soaps do and do not contain fragrances and detergents, which can dry and irritate the skin. Examples include E45 emollient wash cream.

Simple tips when applying emollients:

• When washing your hands use tepid, not hot water.
• Pat your hands dry after washing, rather than rubbing.
• Apply your emollient or moisturiser. Keep a small hand cream in your pocket & aim to apply this every 1-2 hours if you can.
• Apply the emollient gently in the direction of the hair growth. Vigorous rubbing may block hair follicles, causing inflammation (folliculitis) and trigger itching.
• Apply to all areas of the hands, not just dry patches.
• An ointment may be used at night if a heavier emollient is required. Cotton gloves may be handy here to prevent your bedclothes getting greasy.
• Continue using your emollient after your skin has improved to prevent a flare up if continuous handwashing is still being practised.

If these simple steps are not enough, and the condition of your hands continue to deteriorate please do speak to your Pharmacist or GP for other available treatment options.

Jane Fleming MPSI

Supervising Pharmacist

Murphy’s Pharmacy,

Midleton,

Co. Cork.