When the Covid-19 pandemic broke out, populations around the world were repeatedly urged to wash and sanitise their hands as a first defence measure against catching the virus. Unfortunately, the repeated and excessive washing and sanitising of hands can lead to increased skin irritation and atopic dermatitis, otherwise known as eczema, owing to contact with chemical or physical agents such as water, soap and detergent. Once developed, everyday exposure to water and soap will only aggravate eczema, leading to a long-term, chronic condition.
The condition may be even more pronounced for those working in healthcare settings, where medical professionals and support staff use personal protective equipment (PPE) like gloves over prolonged periods. Nurses in particular experience high rates of eczema, with 23 per cent impacted. Add to that the frequent handwashing, regular use of hand sanitiser and chronic levels of stress that come with the job, and eczema of the hands can become seriously debilitating.
Other segments of the population that see a worrying increase in hand eczema are children, with many presenting with the condition following the reopening of nurseries, daycare and schools due to altered hygiene routines. Overall, eczema presents in the highest instance in early childhood, with 60 per cent of patients experience first signs and symptoms before one year of age.
Not only do eczema patients experience itching and pain, but, as a result, many also experience disturbances to their sleep and are unable to participate in social activities that require the heavy use of their hands, such as certain sports. Other symptoms include chronic recurrence of circular eczematous lesions on the skin. In total, 20 per cent of children and up to 10 per cent of adults experience eczema in their lifetimes, and incidence of the condition is on the rise across Africa and the Middle East.
Unfortunately, many people suffering from eczema were either unable to or did not wish to visit their dermatologist or medical centres on account of Covid-19. Yet, at the same time, the pandemic also exacerbated the condition for some patients. From the stress of having to quarantine, staying indoors and reducing exposure to sunlight, increasing exposure to high temperatures, low humidity and indoor pollutants such as tobacco smoke to a reduction of physical activity – these lifestyle changes have been associated with patients experiencing greater itching in chronic skin diseases.
Specific measures, however, can be taken by patients suffering from such skin diseases to prevent their aggravation. Among them are limiting the use of hand sanitiser and replacing it with handwashing when possible – and where the use of hand sanitiser is necessary, those containing glycerol are much softer on the hands. In the case of handwashing, recommendations to offer protection from worsening eczema include using warm water to wet the hands before applying soap and using a lipid-rich moisturiser after washing them.
Where such preventative measures, however, fail to alleviate or prevent eczema, several treatments are available for patients, the most popular being topical corticosteroid creams and other advanced topical options. Applying them locally and intermittently can help treat the disorder with minimal side effects. For more moderate to severe cases, thanks to a growing understanding of the pathophysiology and clinical burden of eczema, new therapies like JAK inhibitors are now available and constitute a revolutionary addition to the condition’s toolbox. Taken orally, such treatments may bring eczema relief for many more patients with minimal side effects.
Understanding eczema’s mechanisms, triggers and preventive measures are key to managing it – particularly against the backdrop of the pandemic, which has in many cases led to a worsening of the condition. While ongoing research into more advanced treatment continues, patients are encouraged to see a healthcare practitioner to determine the best course of treatment. No two eczema patients are the same and seeing a dermatologist is a critical step towards managing this skin disease.