Hands in the era of total disinfection

The skin, subcutaneous tissue and muscle frame of the skin of the hands are poorly developed, and the existing fascia protects deep neurovascular formations. The skin on the back of the hand differs in structure from the skin on the palms. It has a well-defined epidermal layer and virtually no hypodermis. Thanks to this structure, the skin is more elastic. The epidermis contains a lot of melanin, which protects it from exposure to ultraviolet radiation; with age, photoaging of the skin of the hands is manifested by pigmentation. The skin of the palms, on the contrary, is very dense and tough, it is tightly connected to the underlying tissues and is difficult to fold. On the surface of the palms there are a lot of nerve endings, as well as the exits of the sebaceous glands. Based on the condition of the skin of the hands, one can diagnose dermatological, systemic autoimmune diseases, Raynaud's disease, vegetative-vascular dystonia, hyperhidrosis and other diseases.

With age, a decrease in the barrier properties of the skin leads to a loss of elasticity and firmness, the hydration of the epidermis decreases, roughness increases, fine wrinkles and age spots appear, against the background of thinning of the skin and a decrease in the volume of subcutaneous fat, veins and tendons become noticeable, as well as deformation of the bone skeleton of the hands .

Action of external factors

Hands are more often, compared to other areas, exposed to natural factors - low and high temperatures, ultraviolet radiation, wind and constant physical activity aggravate the clinical picture.

The physiological processes of aging and the influence of environmental factors negatively affect the properties of the skin: the protective properties are significantly reduced, the structure changes, elasticity is lost, and excessive dryness appears. Constant hand washing causes the destruction of the natural lipid barrier of the skin. The danger increases when using aggressive cleaning agents and detergents. The breakdown of the surface barrier due to the washing away of the lipid layer makes it impossible to maintain moisture, and the rate of water loss increases. In addition, tap water contains a large amount of salts and is hard, which leads to microtrauma of the skin and imbalance.

Frequent hand washing and disinfection are the most effective measures to prevent the spread of infectious diseases, including the current coronavirus disease. Unfortunately, constant hand washing and use of antibacterial products can negatively affect the condition of the skin. It's no secret that any detergent contains a number of chemicals that are aimed at dissolving and washing away fat and impurities from the surface of the skin. They have a similar effect on the lipid membrane of the skin (dissolve fats, for example, ceramides). As a result, the skin becomes dry (often compared to parchment). Also, certain chemicals contribute to the loss of connections between epidermal cells, which leads to dryness and flaking. Skin lacking a protective lipid layer and connections between epithelial cells is more prone to damage from detergents and disinfectants. Alcohol-based antiseptics denature proteins, thereby damaging viral capsids and bacterial membranes. This allows you to destroy microorganisms on surfaces on which the sanitizer comes in contact. But antiseptic substances also have a similar effect on the skin. Denaturation of proteins that make up skin cells leads to compaction and hardness of its surface.

Hand dermatitis

Hand dermatitis, or eczema, is common and affects approximately one in 20 people. The condition may begin in childhood as a manifestation of a genetically determined tendency toward eczema, but is most common in adolescents and adults. Dermatitis can be a short-term problem, but for some people it lasts for years and can have a big impact on daily life.

People who had eczema as a child (atopic eczema), as well as those whose work involves frequent contact with water and hand washing, are at high risk of developing dermatitis.

What causes hand dermatitis? Many people experience hand dermatitis due to direct damage to the skin from harsh chemicals as well as irritants, especially soap, detergents and repeated contact with water. This is called irritative contact dermatitis.

Skin contact with allergens such as perfumes, fragrances, metals, rubber or leather can also cause dermatitis in people who are allergic to these substances. This is called allergic contact dermatitis.

However, in many cases, the cause of a patient's hand dermatitis is unknown and the trigger cannot be determined. Also often the cause of hand dermatitis is, for example, a combination of atopic dermatitis and irritative or allergic contact dermatitis.

What are the symptoms of hand dermatitis? The affected areas of the skin may be hot and painful to the touch, with peeling and itching. Elements of the rash - small blisters, spots, cracks - can cause pain when moving the fingers or hand.

With dermatitis, the skin of the hands is inflamed, red and swollen, with a damaged, dry or scaly surface, making it rough. There are cracks that often bleed, and sometimes small water blisters can be seen on the palms or sides of the fingers. Various parts of the hand may be affected. Hand dermatitis can be caused by bacteria, such as staphylococci or streptococci. This results in more redness, tenderness, crusting, exudation, blemishes or pimples.

Diagnosis of dermatitis is made by a thorough examination of the skin. Examination of other areas of the body will confirm or refute the spread of the pathological condition to other areas of the skin. It is advisable to do a patch test to identify the cause of allergic dermatitis.

Can other skin conditions look like hand dermatitis? Hand psoriasis can resemble dermatitis, especially when there are thick, scaly patches on the palms. Ringworm or a fungal infection also causes itchy, scaly rashes. These diseases usually start in the legs or groin, but can spread to the hands and nails, and sometimes affect only one hand. To carry out differential diagnosis, it is necessary to carry out tests prescribed by the doctor.

Treatment of hand dermatitis

In most cases, treatment controls the condition but does not cure it completely. Early detection and treatment can help avoid problems associated with hand dermatitis. For people with allergic contact dermatitis, avoiding the allergen may help reduce or eliminate the symptoms of the dermatitis.

Moisturizers (emollients, emollients) are an important part of the treatment of hand dermatitis. They help restore externally damaged skin and retain moisture inside the skin, making it soft and elastic again. They should be applied repeatedly throughout the day and whenever the skin becomes dry. They also serve to reduce the risk of secondary bacterial infection. Using emollient cleansers as soap substitutes is very important because they not only cleanse the skin, but also do not dry out or damage it like liquid or solid soap.

Steroid creams and ointments are the most common way to treat hand dermatitis. They relieve symptoms and soothe inflamed skin. Typically, more concentrated steroids are needed because mild steroids (1% hydrocortisone) do not work on thick skin. They are used up to twice a day without fail (!) on the recommendation of a doctor in accordance with the indications.

Antihistamines are rarely effective for hand dermatitis. These medications are not useful for most people with eczema and are not recommended for routine use. Sometimes taking it is justified for several days, during the acute phase of the process.

Calcineurin inhibitors are creams and ointments that are used to treat dermatitis instead of steroids. Although their effectiveness is less than that of strong corticosteroids, they do not carry the risk of skin atrophy. May often cause a burning sensation after application.

Ultraviolet therapy is used to treat very severe dermatitis.

Systemic corticosteroids can be taken for several weeks for severe exacerbation of hand dermatitis. Usually the dose is reduced gradually over several weeks. Longer use is not recommended due to side effects.

Alitretinoin, created on the basis of vitamin A, is prescribed by specialists for severe, long-term hand dermatitis. The course of treatment usually lasts up to 6 months. This drug is contraindicated during pregnancy.

Systemic immunosuppressants (azathioprine, cyclosporine, and methotrexate) are powerful drugs that are sometimes prescribed to treat severe hand dermatitis. Such treatments are usually reserved for more severe cases or when other treatment options fail to control symptoms. Patients taking immunosuppressants should have their blood counts monitored regularly.

Prevention of hand dermatitis

It is important to always use protective gloves, both at work and at home, when coming into contact with irritating chemicals and water.

The choice of glove material (rubber, PVC, nitrile, etc.) depends on what chemicals or allergens you plan to work with. Gloves must be clean and dry inside. You can wear cotton gloves underneath (or just choose lined gloves) if you have to work for a long time. If the use of gloves itself leads to dermatitis, then a protective cream should be applied to the hands before exposure to possible irritants. After completing the work, you must carefully wash your hands with a mild detergent, dry thoroughly, and then moisturize with special products.

The coronavirus disease COVID-19 continues to spread throughout the world, outpacing the capacity and resources of healthcare systems around the world. Because the virus is highly contagious through the respiratory route (droplets from infected people are spread widely when they cough or sneeze) and through contact with contaminated surfaces, transmission and spread in the community can be reduced by regular and thorough hand hygiene. Frequent hand washing involves prolonged exposure to water and other chemical or physical agents and can cause several pathophysiological changes such as disruption of the epidermal barrier, disruption of keratinocytes, subsequent release of proinflammatory cytokines, activation of the skin immune system and a delayed type of hypersensitivity reaction. Dermatological side effects such as excessive dry skin or even contact dermatitis may occur, especially in individuals with a history of atopic dermatitis. These skin conditions are ideally treatable, and applying moisturizer immediately after washing your hands or after using a portable hand sanitizer is the cornerstone in preventing the development of eczematous hand skin changes.

In the current global context, the possible occurrence of these dermatological side effects should in no way cause people to deviate from strict hand hygiene practices.

People with hand eczema/dermatitis have reduced lipids (fats) in the skin on their hands, so they should generally avoid soap. However, due to the COVID-19 pandemic, it is now recommended that even those suffering from hand dermatitis use soap to wash their hands for 20 seconds. Then you should wipe your hands dry with a disposable paper towel. It is recommended to use a moisturizer immediately after washing. If soap and water are not available, hand sanitizer gels should be used.

WHO recommends that healthcare workers disinfect their hands using an alcohol-based rub unless their hands are visibly dirty. If you become noticeably contaminated with blood or other body fluids, wash your hands with soap and water.

Teach your patients how to properly care for their hands when using antiseptics frequently. Moisturizing generously with the richest hand moisturizer can help prevent the problem. Typically, a light moisturizing hand cream is recommended every 1-2 hours during the day and a rich moisturizing cream at night (you can use cotton gloves).

Hands should always be dry, with careful use of gloves. Before working in a damp environment, use a moisturizer and wear light cotton gloves, followed by rubber or PVC gloves for household work, or industrial or gardening gloves for heavy work. Every 15 minutes you need to take a break, take off your gloves and moisturize your hands again. Cotton gloves themselves are suitable for “dry” work, surgical latex gloves are suitable for delicate wet work.

Direct contact of hands with detergents should be avoided. Shower gel, shampoo and conditioner should also be chosen with care (Elave products may be suitable) or surgical gloves should be worn when showering and washing hair. Rings should only be worn on special occasions, never while working, and cheap jewelry should be avoided (18k gold, silver or stainless steel are safe).

Advise clients to purchase a sufficient number of gloves and hand moisturizers and place them everywhere (both at home and at work) so that they do not have to look for them every time or go somewhere specially to get them.

Sudden deterioration of a client's hand skin condition should prompt a visit to you or a physician, as special care may be needed, including antibiotics, steroid ointments, and laboratory tests or special investigations.

First published: PRO Cosmetology by Cosmetologist No. 5-6, 2020