Contact allergy investigations in healthcare workers with face mask-related skin disease.

BACKGROUND: During the COVID-19 pandemic, the use of face masks has increased among healthcare workers (HCWs). Questionnaire studies have shown a high frequency of self-reported facial adverse skin reactions. Case reports have been published on face mask-induced allergic contact dermatitis and urticaria. OBJECTIVES: To describe the results of the contact allergy investigations in consecutive HCWs investigated for skin reactions to face masks during the COVID-19 pandemic and the results of the chemical investigations of face masks supplied by the hospital. METHODS: Participants were patch tested with baseline series and chemicals previously reported in face masks not included in the baseline series. Face mask(s) brought by the HCW were tested as is and/or in acetone extract. Chemical analyses were performed on nine different face masks for potential allergens. RESULTS: Fifty-eight HCWs were investigated. No contact allergies were found to the face mask(s) tested. Eczema was the most common type of skin reaction, followed by an acneiform reaction. Colophonium-related substances were found in one respirator and 2,6-di-t-butyl-4-methylphenol (BHT) were found in two respirators. CONCLUSION: Based on this report, contact allergies to face masks is uncommon. Patch test with colophonium-related substances and BHT should be considered when investigating adverse skin reactions to face masks.

Occupational dermatitis virtual clinic for healthcare workers: clinics to increase training opportunities to dermatology registrars who are working from home

During the COVID-19 pandemic, there has been a demand from frontline healthcare workers (HCWs) wanting dermatological advice for occupational dermatitis due to increased infection-prevention measures. Various dedicated occupational skin disease clinics in the UK have been set up to help these HCWs, from virtual clinics to drop in clinics (O'Neill H, Narang I, Buckley D et al. Occupational dermatoses during the COVID-19 pandemic: a multicentre audit in the UK and Ireland. Br J Dermatol 2021;184: 575-7). These clinics provide an opportunity for dermatology registrars to enhance their training in contact dermatitis and teledermatology. In a nationwide survey conducted in January 2020, it was felt that dermatology trainees lacked confidence in handling teledermatology referrals (Lowe A, Pararajasingam A, Goodwin RG. A paradigm shift in trainee confidence in teledermatology and virtual working during the COVID-19 pandemic: results of a follow-up UK-wide survey. Clin Exp Dermatol 2021;46: 544-7). At our institution, a virtual telephone clinic has been set up with occupational health input. A standardized pro forma is given and each person sends photos with an occupational health referral to an encrypted email service. By having this additional information beforehand, a history can be taken in the telephone clinic and appropriate management advice given. There is a dermatology consultant who is on hand to help with any queries that the trainee may have. Medications are sent out to the patient and a letter is copied to the patient, as well as the general practitioner, which details the consultation. The patients are usually discharged from the service;however, if the patients need to be seen a face-to-face appointment is given. In these clinics, various occupational dermatoses have been seen and managed. The most common diagnosis was irritant contact dermatitis of the hands due to increased handwashing and alcohol gel use, and most of these patients have a previous diagnosis of atopy (O'Neill et al.). Other occupational dermatoses seen include allergic contact dermatitis, acne and flare-up of atopic eczema. Owing to the COVID-19 pandemic, some dermatology registrars may be working from home. By doing these clinics, training opportunities in dermatology can continue with registrars still seeing patients virtually and managing the conditions. Teledermatology is being introduced in the new dermatology curriculum from August 2021. This service is also appreciated by the HCWs with these patients being seen promptly and getting their conditions managed, maintaining wellbeing in staff.

Post-COVID Cutaneous Manifestations: A Retrospective Study at a Tertiary Care Centre

Introduction: COVID-19 disease is caused by SARS COV-2 virus. Though it primarily affects the lower respiratory tract, reports have indicated that specific cutaneous manifestations are associated with COVID-19. Objective(s): To evaluate the persistent dermatologic long term sequelae of SARS-CoV-2 infection, among recovered COVID-19 infected patients. Method(s): Baseline data were retrospectively collected from patient's medical records from the department of dermatology over 1 year (January 2021-January 2022), at a designated tertiary care centre. The demographic data, severity of COVID disease, and pre-existing cutaneous and systemic co-morbidities were noted. Dermatologic, hair and nail manifestations were recorded. The results were statistically analyzed. Result(s): Record of total 972 patients were analyzed in our study, with 432 males and 340 females. Out of these, 88 cases (9.05%) had skin manifestations, of which 35 (39.77%) were male, and 53 (60.22%) were females. About 50% of cases experienced long term skin diseases after 6 months of the recovery. The majority, 47 (53.4%) of patients with skin manifestations, were in the age group of 30-50 years, followed by 31 (35.22 %) of patients in the 50 years age and above group. Urticaria and Pruritus were the most common manifestations 26 (29.5%), followed by telogen effluvium 24 (27.7%), herpes zoster 16(18.1%), pityriasis rosea, acneform eruptions, acral erythema, irritant contact dermatitis, palmar keratoderma, aphthous ulcer with lip crackling, eruptive pseudo angiomatosis, aquagenic keratoderma, and others. Conclusion(s): Prevalence of cutaneous, hair and nail manifestations among COVID-19 patients was 88 (9.05%) in our study. More extensive research is required to establish our knowledge on the relation between skin and COVID-19.Copyright © 2023, Dr Yashwant Research Labs Pvt Ltd. All rights reserved.

Occupational Skin Dermatitis among Healthcare Workers Associated with the COVID-19 Pandemic: A Review of the Literature.

The skin is the outermost layer of the human body and is continually exposed to numerous external stimuli, which can cause unwanted skin irritation. Occupational skin diseases are the most prevalent form of work-related illness and are found in a variety of sectors, particularly healthcare. During the recent COVID-19 pandemic, healthcare professionals experienced a variety of unexpected, unusual occupational skin diseases associated with COVID-19-engaged employment. Because the clinical characteristics of these types of skin inflammation are unique, this review focuses on the characteristics of a large category of occupational workers, namely COVID-19-engaged healthcare professionals. Furthermore, we examined the potential pathogeneses of occupational skin disorders associated with COVID-19-engaged labor, as well as different preventative methods.

Maskne: A side effect of wearing face mask and face mask-wearing attitudes and behavior during 1st, 2nd and 3rd waves of COVID-19 in rural population of Haryana.

Introduction: The term "maskne" originated during the SARS CoV-2 (COVID-19) pandemic; it is a variant of acne associated with continuous wearing of face mask. Maskne is mainly observational, and the most common cause of maskne is contact irritant dermatitis. Materials and methods: The average mask use percentage by OPD cases visiting the hospital for a month in each wave of the COVID -19, that is, in the month of June 2020 during the first wave, in the month of April 2021 during the second wave and in the month of December 2021 during the third wave was calculated. We also included 30 patients with a diagnosis of irritant contact dermatitis aka maskne and 30 patients with diagnosis of acne vulgaris, all >18 years of age from April 2020 to December 2021. Results: 66% of people wore masks coming to hospital in the month of June 2020 (first wave) which increased to 74% during the second wave in the month of April 2021 and during the third wave only 23% of people wore masks in the month of December 2021. Conclusion: Maskne and worsening of acne vulgaris can be due to wearing of dirty face masks for longer duration. Use of moisturizers and regular "mask breaks" are important aspects in management of maskne.

Optimization of common hand cleansers for protection from viral spread and occupational hand dermatoses

Irritant contact dermatitis (ICD) affects over 20% of health care workers, who manage their condition by substituting soap with an emollient cleanser. It is not clear whether emollient cleansers have the same level of virus eliminating activity as soap. Therefore, we evaluated a range of emollient cleansers for virus eliminating activity against enveloped (coronavirus and herpes simplex virus) and nonenveloped viruses (adenovirus (Ad)). In accordance with European standards a range of cleansers were combined with viruses under different (‘clean’ and ‘dirty’ hand hygiene) conditions. Virus viability and architecture were determined by plaque /TCDI50 assays and transmission electron microscopy. Traditional soaps (natural fatty acid), synthetic soaps and emollient cleansers (e.g., ceramide-containing cleansers) exhibited significant antiviral activity in enveloped viruses. However, the antiviral activity of traditional soaps reduced drastically when combined with hard water. Moreover, nonenveloped viruses were less susceptible to both synthetic soaps and emollients cleansers. Interestingly, traditional soaps inhibited the viability of Ad at high concentrations, but only in soft water. Most emollient cleansers were effective at eliminating enveloped viruses, suggesting that they are an acceptable substitute for soap to control the spread of viruses, like SARS-CoV-2, and protect against ICD. Nonenveloped viruses showed resistance to most of the hand hygiene products tested, except for traditional soap. This suggests that hand washing alone may not be sufficient to control the spread of nonenveloped viruses. Taken together this suggests that different virus strains respond differently to soaps and cleansers, and that this should be considered in the guidance for hand hygiene.

Contact allergy investigations in healthcare workers with face mask-related skin disease

Background: In the last 10 year prior to the COVID-19 pandemic approximately 1 healthcare worker (HCW) per year has been investigated for suspected occupational facial skin disease at our department. In contrast, during the present pandemic several HCWs has been investigated because of suspected occupational facial skin disease. Objectives: To report the findings in consecutively investigated HCWs with occupational facial skin disease. Methods: More than 40 HCWs has been investigated including patch test with their own face mask as is and with acetone extracts of the masks. Chemical analyses of potential allergens been performed in a number of different brands of face masks. Results: In all cases the skin disease was of recent onset. The most common diagnoses were irritant dermatitis and acne or acne-like eruptions including perioral dermatitis. No occupational contact allergies were found, and all patch tests with face masks were negative. Chemical analysis indicated colophonium-related substances in one brand of face mask. Conclusions: Based on referral pattern there has been increase of occupational facial dermatitis during the pandemic. Irritant factors like occlusion and friction appears to be the most common cause while contact allergy to the masks were not detected in this population.

Contact dermatitis in healthcare workers: epidemic at the height of the COVID-19 pandemic?

Healthcare workers (HCWs) are generally exposed to a considerable amount of wet work - including a high frequency of hand washing and long wearing periods of protective gloves with accompanying heat congestion and sweating by occlusion - and thus a high risk of developing hand eczema (HE), mainly caused by irritant contact dermatitis. Intensified hand hygiene measures have been implemented for containing the coronavirus disease 2019 (COVID-19) pandemic which emerged in the beginning of 2020 and has led to increased skin strain in the general population and particularly in HCWs who face a double burden due to elevated hygiene measures both in private life and at work. Recent studies verify that prevalence of occupational dermatoses in HCWs has increased during the COVID-19 pandemic. Recommendations for preventing occupational HE include the use of adequate skin cleansing substances and skin care products, which can be taught within health education programs. It was previously shown that health education interventions are effective in the prevention of occupational dermatoses and especially HE. The unprecedentedly high incidence of contact dermatitis in HCWs associated with COVID-19-associated hygiene measures entails the need for tailored HE prevention strategies to preserve the working ability of HCWs who are urgently needed in tackling the pandemic and its consequences. Current findings and future perspectives will be discussed in this speech.

Contact dermatitis in healthcare workers: Results of patch testing and review of the literature

Aim: Occupational contact dermatitis (OCD) is common amongst healthcare workers (HCW). This retrospective study describes the causes of allergic contact dermatitis in HCW in New Zealand and reviews the current literature review on OCD in HCW during the COVID-19 pandemic. Material and Methods: All HCW undergoing patch testing between July 2008 and January 2020 at a public hospital patch-test clinic, and between June 2019 and January 2020 at a private dermatology clinic were included. Data collected included patient demographics, occupation, results of patch testing and pre and post-patch test diagnoses. Literature search was performed on Pubmed with keywords: healthcare workers, occupational, allergic contact dermatitis (ACD), irritant contact dermatitis (ICD), COVID-19. Results: Out of 837 patients patch tested during the study period, 67 were HCW. The mean age of HCW was 41 years (standard deviation 14) and 58 (87%) were female. The most common occupations were nurses (40%), allied health (22%) and doctors (18%). Forty-six (69%) patients had a background of atopic dermatitis. Hand dermatitis was the most common presentation (49%), followed by facial/neck dermatitis (25%). The most common relevant positive reactions were to rubber accelerators (24%), fragrances (16%), perservatives (15%) and topical steroids (9%). Literature review reflects that the incidence of ICD increased significantly due to increased frequency of hand washing and use of personal protective equipment during the COVID-19 pandemic. Contemporary data regarding ACD is limited. Conclusion: The most common allergens in HCW are rubber chemicals, fragrances and preservatives. The COVID- 19 pandemic has highlighted the incidence of OCD amongst HCWs. While rates of ICD have risen, data does not yet suggest increased rates of ACD.

Effects of skin washing frequency on the epidermal barrier function and inflammatory processes of the epidermis: An experimental study.

BACKGROUND: Increased hand hygiene measures during the COVID-19 pandemic have led to an increased quantum of hand eczema (HE). OBJECTIVES: To examine the effects of varying washing frequencies using current mild cleansing agents-alongside with the effect of a rehydrating cream-on the epidermal barrier function and inflammatory processes of the stratum corneum(SC). METHODS: Standardized skin washings on the volar aspects of the lower arms of skin-healthy volunteers were performed using the automated cleansing device either 5 or 11 times within 4 h for 60 s each with a standard cleanser, a lipid-containing syndet, or a lipid-containing syndet followed by one-time application of a rehydrating cream. Skin bioengineering parameters (transepidermal water loss, SC hydration, erythema, and SC pH) and biochemical/immunological parameters (interleukin-1α, interleukin-1α receptor antagonist and natural moisturizing factor) of SCsamples collected by tape stripping were assessed. RESULTS: All applied washing procedures provided comparable, mild effects on the epidermal barrier function and skin inflammation. CONCLUSION: Occupational skin cleansers seem to have improved regarding skin barrier damaging effects. To further corroborate this, a study design, modified on the basis of our findings, applying longer washing periods for consecutive days seems desirable.

Personal protective equipment-related occupational dermatoses during COVID-19 among health care workers: A worldwide systematic review.

BACKGROUND: Occupational dermatoses caused by personal protective equipment (PPE) in the ongoing COVID-19 pandemic are emerging occupational health challenges that must be promptly and effectively addressed to ease burden on our health care workers. OBJECTIVE: A systematic review was conducted to determine common PPE-related dermatoses, affected body sites, and implicated occupational contactants. We further proposed solutions to mitigate this problem. METHODS: Online databases were searched for articles on PPE-related dermatoses in health care workers during the COVID-19 pandemic written in English and published from January 1, 2020, to January 30, 2021. RESULTS: Sixteen studies, including a total of 3958 participants, were included. The most common dermatoses were xerosis, pressure-related erythema, and contact dermatitis, mainly affecting the face and hands. The most widely implicated contactants were increased frequency of hand hygiene, gloves, N95 masks, and goggles. Proposed solutions were categorized as individual self-care, protection of the workforce, and long-term preventive measures. CONCLUSION: Through measures such as regular basic skin care education, early access to specialty clinics via telemedicine, and designing of better-fit PPE, the challenges posed by PPE-related occupational dermatoses can be significantly reduced.

Occupational Dermatoses Related to Personal Protective Equipment Used During the COVID-19 Pandemic.

The recent coronavirus disease 2019 (COVID-19) pandemic has led to the dramatic increase in use of personal protective equipment (PPE) among health care providers and the general public. Herein the authors discuss the various occupational dermatoses including allergic and irritant contact dermatitis, acne, seborrheic dermatitis, and rosacea related to frequent handwashing, disinfecting of surfaces, and prolonged wear of various PPE including face masks, gloves, and gowns. The authors provide an overview of published PPE-associated occupational dermatoses during the COVID-19 pandemic and also discuss prevention strategies and treatment options to help patients with these complaints.

Fluctuating Palmar Erythema in a Toddler during COVID-19 Pandemic: Do You Know the Offender?

Palmar erythema in children can be due to various reasons, such as chronic liver disease, rheumatological disorders, medications, irritant contact dermatitis and atopic dermatitis. Recently, there are few reports about contact dermatitis caused by frequent, daily use of hand sanitizers during this COVID-19 pandemic. A 3-year-old toddler brought with the concern of waxing-waning bilateral palmar erythema for the past 2 weeks. The parents revealed that the child liked the bright color of a recently bought hand sanitizer bottle so much he used to wash his hands every 20-30 min throughout the day. The atypical presentation of contact dermatitis might be because the child was using the sanitizer more frequently during the daytime. The dermatitis resolved with stopping excessive use of the hand sanitizer by the toddler. Clinicians should be aware of contact dermatitis during these pandemic times. Instead of investigating them extensively, careful history taking and merely advising them to judicially utilize the sanitizer can lead to complete reversal of symptoms.

Comparing the quantitative fit-testing results of half-mask respirators with various skin barriers in a crossover study design: a pilot study.

BACKGROUND: Clinicians around the world are experiencing skin breakdown due to the prolonged usage of masks while working long hours to treat patients with COVID-19. The skin damage is a result of the increased friction and pressure at the mask-skin barrier. Throughout the COVID-19 pandemic, clinicians have been applying various skin barriers to prevent and ameliorate skin breakdown. However, there are no studies to our knowledge that assess the safety and efficacy of using these skin barriers without compromising a sufficient mask-face seal. AIM: To conduct the largest study to date of various skin barriers and seal integrity with quantitative fit testing (QNFT). METHODS: This pilot study explored whether the placement of a silicone scar sheet (ScarAway®), Cavilon™, or Tegaderm™ affects 3M™ half-face mask respirator barrier integrity when compared to no barrier using QNFT. Data were collected from nine clinicians at an academic level 1 trauma centre in New Jersey. FINDINGS: The silicone scar sheet resulted in the lowest adequate fit, whereas Cavilon provided the highest fit factor when compared to other interventions (P < 0.05). CONCLUSION: These findings help inform clinicians considering barriers for comfort when wearing facemasks during the COVID-19 pandemic and for future pandemics.

Evaluation of hand hygiene and onset of hand eczema after the outbreak of SARS-CoV-2 in Munich.

BACKGROUND: Since the outbreak of SARS-CoV-2, authorities have preached the importance of personal hygiene, including hand washing and disinfection. OBJECTIVE: To evaluate changes in the frequency of hand washing and hand care, the onset of hand eczema (HE) and risk factors associated with HE since the outbreak of SARS-CoV-2 in Munich in January 2020. MATERIALS & METHODS: All dermatologic outpatients at the university hospital between April 6 and April 19 were asked to complete a structured questionnaire. RESULTS: Data of 512 patients with a median age of 49 years (243 females, 267 males) were analysed. The frequency of hand washing and hand disinfection increased after the outbreak of SARS-CoV-2 (p < 0.001, respectively). While symptoms associated with HE were reported by 29.9% (149/499) of patients, the actual diagnosis of HE was reported less frequently by 11.2% (53/473) with a median duration of 120 days. Frequent hand disinfection (p = 0.039), atopic dermatitis (p = 0.006) and young age (p = 0.0499) were identified as risk factors for symptoms of HE. Hand care was performed more frequently during the pandemic than before (p < 0.001). A high frequency of hand care during the pandemic was not significantly associated with symptoms of HE (p = 0.172), but was associated with self-recognition of HE symptoms (p = 0.002). CONCLUSION: After the outbreak of SARS-CoV-2, the frequency of hand hygiene measures increased. A considerably high prevalence of HE symptoms was associated with frequent hand disinfection, atopic dermatitis and young age. Awareness of HE should be raised in order for preventive measures to be taken earlier.

How irritant are n-propanol and isopropanol? - A systematic review.

BACKGROUND: The use of alcoholic-based hand rubs (ABHRs) is an important tool for hand hygiene, especially in times of the COVID-19 pandemic. Possible irritant effects of ABHR may prevent their use by persons at risk of infection. METHODS: This systematic review is based on a PubMed search of articles published between January 2000 and September 2019 in English and German, and a manual search, related to the irritation potential of alcohol-based disinfectants restricted to n-propanol (1-propanol) and its structural isomer isopropanol (isopropyl alcohol, 2-propanol). RESULTS: The majority of the included studies show a low irritation potential of n-propanol alone. However, recent studies provide evidence for significant barrier damage effects of repeated exposure to 60% n-propanol in healthy, as well as atopic skin in vivo. The synergistic response of combined irritants, (ie, a combination of n-propanol or isopropanol with detergents such as sodium lauryl sulfate) is greater, compared with a quantitatively identical application of the same irritant alone. CONCLUSION: While recent studies indicate a higher risk of skin irritation for n-propanol and isopropanol than reported in the past, this risk still seems to be lower than that for frequent handwashing with detergents, as recommended by some to prevent COVID-19 infections.

Hand hygiene during COVID-19: Recommendations from the American Contact Dermatitis Society.

The recent COVID-19 pandemic has resulted in increased hand hygiene and hand cleansing awareness. To prevent virus transmission, the Centers for Disease Control and Prevention recommends frequent hand washing with soap and water. Hand hygiene products are available in a variety of forms, and while each of these formulations may be effective against COVID-19, they may also alter skin barrier integrity and function. As health care workers and the general population focus on stringent hand hygiene, the American Contact Dermatitis Society anticipates an increase in both irritant contact and allergic contact hand dermatitis. Alcohol-based hand sanitizers with moisturizers have the least sensitizing and irritancy potential when compared to soaps and synthetic detergents. This article provides an overview of the most frequently used hand hygiene products and their associations with contact dermatitis as well as recommendations from the American Contact Dermatitis Society on how to treat and prevent further dermatitis.