Frequent Hand Washing and Eczema in British Children

Frequent Hand Washing and Eczema in British Children

As a result of the COVID-19 outbreak, parents have become even more vigilant about  ensuring their children wash their hands regularly. And rightly so. The advice is unanimous  that hand washing is a key strategy in helping prevent the spread of the virus.[1] However, it is  not without its drawbacks—an increasing number of children are suffering from skin problems  as a direct consequence of frequent handwashing. One of the more common problems is hand  eczema. Prior to the pandemic, it was estimated that around 10-15% of people were  affected,[2] but a recent survey by the British Skin Foundation suggests it could now be  affecting almost 1 in 4 children.[3]

Why is this happening, and what can be done about it? 

What is hand eczema? 

Hand eczema, also called hand dermatitis, involves redness and itching of the hands. It is  usually accompanied by dry skin, sometimes to the point of cracking or peeling, and may be  extremely uncomfortable or even painful.[2] It can be caused by an underlying condition, like  atopic dermatitis, or may be the result of repeated use of an irritating substance, like soap,  alcohol or other substances. The webbing between the fingers is often the first place to be  affected, but it can spread to the fingers, the back of the hands and wrists.

How does frequent washing cause hand eczema? 

To answer this question, we first need to look briefly at the skin’s natural defence system.  Even before we get to the skin itself, our bodies are protected by a host of bacteria, fungi and  other microbes that live on our skin, called the skin microbiome. This performs functions like  balancing skin pH and killing opportunistic pathogens that might like to take up residence.[4]

Below that, there are the ‘bricks and mortar’, skin cells and lipids, that make up your skin  barrier—a structure responsible for keeping irritating substances out, and moisture in. 

Traditional soap can have a detrimental effect on both these systems. Soap has a very high  pH, which disrupts the normally low pH environment of skin, killing off some of the beneficial  skin bacteria, and encouraging the growth of harmful microbes like S. aureus.[5]

Soap and other harsh surfactants can also damage the skin barrier, leading to dryness and  making it more likely for allergens to enter, potentially causing irritation.[6] Once this process  begins, the skin can become trapped in a negative feedback cycle, where the dry, itchy skin  encourages scratching, which causes inflammation and further damages the skin barrier,  making the whole situation worse.[7]

How atopic dermatitis fits in 

Hand eczema is more common in children with atopic dermatitis.[2] This is because a main  feature of atopic dermatitis is a weakened skin barrier, often accompanied by changes to the  microbiome (increased levels of S. aureus), which, as discussed above, are precursors for  irritation. In a sense, their defences are already lowered, even in areas of skin that appear  healthy,[8] so when combined with the sort of aggravation that comes with frequent hand  washing, further flare-ups can be difficult to avoid. 

Tips to help manage dry skin from hand washing 

Children are not the only ones being affected by the drawbacks of frequent hand washing. In  a recent survey of healthcare workers, it was found that hand washing frequency had more  than doubled because of the COVID-19 pandemic and more than 80% of healthcare workers  surveyed reported dryness.[9] Redness, itch, burning and other issues were also common. To 

address this issue, experts have released tips and guidelines to help curb the problems. Since  we’re all washing our hands more often, these tips are useful for all of us.[10,11]

 

Tips to help manage dry skin from hand washing

1. Don’t stop washing hands (or using an alcohol-based hand sanitiser when a cleanser  and water are not available) – we must continue washing our hands frequently and  encouraging our children to do the same to help prevent the spread of COVID-19 

2. Use soap-free cleansers over harsh soaps – soap-free cleansers are much gentler  on skin and are pH balanced to avoid disrupting the skin’s natural pH. QV Gentle  Wash, for instance, is a pH balanced, soap-free, fragrance-free cleanser that is gentle  on irritated skin and suitable for use with dry skin conditions such as eczema.  

3. Use warm, not hot, water – frequent use of hot water can strip the skin of natural  moisturising oils, causing hands to dry out faster. 

4. Ensure hands are properly dried – wet hands can make it more likely for germs to  grow and spread and increase irritation caused by friction. 

5. Use moisturisers after drying hands – a fragrance-free moisturiser helps counter  the drying effect of frequent washing. During the day, a light moisturising lotion, like  QV Skin Lotion, is ideal. It’s non-greasy and quickly absorbed, making it ideal for 

routine use. For drier skin, QV Cream is a richer, more concentrated moisturiser that  provides 24h hydration. For children with extremely dry skin, try QV Intensive Ointment  at night, which is water-free so it won’t sting when used on cracked skin. All QV moisturisers are fragrance-free and suitable for sensitive skin and dry skin  conditions such as eczema. 

References 

  1. Alzyood M, Jackson D, Aveyard H, Brooke J. COVID‐19 reinforces the importance of  handwashing. J Clin Nurs [Internet] 2020 [cited 2020 Aug 21];Available from:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7267118/ 
  2. Oakley A. Hand dermatitis [Internet]. DermNet NZ2018 [cited 2020 Aug 19];Available  from: https://dermnetnz.org/topics/hand-dermatitis/ 
  3. Over half of British children are suffering with skin problems due to frequent  handwashing [Internet]. British Skin Foundation2020 [cited 2020 Aug 12];Available from:  https://www.britishskinfoundation.org.uk/news/over-half-of-british-children-are-suffering with-skin-problems-due-to-frequent-handwashing-and-eczema-rates-are-on-the-rise 
  4. Ladizinski B, McLean R, Lee KC, Elpern DJ, Eron L. The human skin microbiome. Int J  Dermatol 2014;53(9):1177–9.  
  5. Lambers H, Piessens S, Bloem A, Pronk H, Finkel P. Natural skin surface pH is on  average below 5, which is beneficial for its resident flora. Int J Cosmet Sci 2006;28:359– 370.  
  6. Voegeli D. The effect of washing and drying practices on skin barrier function. J Wound  Ostomy Continence Nurs 2008;35(1):84–90.  
  7. Yosipovitch G, Misery L, Proksch E, Metz M, Ständer S, Schmelz M. Skin Barrier  Damage and Itch: Review of Mechanisms, Topical Management and Future Directions.  Acta Dermato-Venereologica 2019;99(13):1201–9.  
  8. Agrawal R, Woodfolk JA. Skin Barrier Defects in Atopic Dermatitis. Curr Allergy Asthma  Rep 2014;14(5):433.  
  9. Guertler A, Moellhoff N, Schenck TL, Hagen CS, Kendziora B, Giunta RE, et al. Onset of  occupational hand eczema among healthcare workers during the SARS-CoV-2  pandemic–comparing a single surgical site with a COVID-19 intensive care unit. Contact  Dermatitis 2020; 
  10. Abtahi-Naeini B. Frequent handwashing amidst the COVID-19 outbreak: prevention of  hand irritant contact dermatitis and other considerations. Health sci reports 2020;3(2).  
  11. Balato A, Ayala F, Bruze M, Crepy M-N, Gonçalo M, Duus Johansen J, et al. European  Task Force on Contact Dermatitis statement on coronavirus 19 disease (COVID-19)  outbreak and the risk of adverse cutaneous reactions. J Eur Acad Dermatol Venereol  2020;