As we enter the cold weather season during a pandemic, many of us will suffer from unusually dry skin, especially dry hands from all that washing! On top of your typical winter skincare, we have to be aware of the excess hand-washing due to preventing COVID-19 on top of it.
Let’s get to the bottom of what causes this unpleasant side effect of our good hygiene and learn what we can do about it!
What is hand dermatitis?
Hand dermatitis is a general term for inflammation of the skin on the hands.
There are 3 general categories of hand dermatitis:
- irritant contact dermatitis (ICD)
- allergic contact dermatitis (ACD)
- atopic dermatitis (AD)
—Irritant Contact Dermatitis (ICD):
The most common form of hand dermatitis is irritant contact dermatitis, meaning common (or uncommon) irritants contact the skin and can cause a rash.
Acute ICD can be caused by strong chemicals such as acids and bases which may be seen more commonly in occupations such as manufacturing/cleaning, where hands are exposed to caustic chemicals without protection.
Chronic ICD is the more common form of hand dermatitis, which is caused by repetitive use of mild irritants, such as soap and water. Overtime, these remove lipids (fats) and water-retaining substances of the skin, which increases water loss from the skin, and causes more inflammation and skin turnover.
A helpful analogy I was taught is to think of a muddy field that gets rained on and then immediately the sun comes out the next day and dries the field. The mud will appear “cracked” because of the quick wet-dry cycle. Our hands are like the field, and once they become chronically exposed to soap and water, they start to dry out and become irritated.
Signs of Irritant Contact Dermatitis: Symptoms usually start with dry skin on the hands, and progress to burning and itching, and fissures. Hand dermatitis is usually worse in the winter months due to low humidity, which creates increased permeability to irritants (including soap and water).
Most of us are now being more vigilant than ever about washing our hands to prevent the spread of disease. And while this is so important, it will also be the cause of many cases of Irritant Contact Dermatitis on the hands! We’ll talk more about this later in the article.
–Allergic Contact Dermatitis (ACD):
Allergic contact dermatitis of the hands is less common than irritant contact dermatitis.
The most common example of ACD is poison ivy. On the hands, ACD is caused by gloves (latex, rubbers) or acrylates (glues) in medical gloves. To diagnose ACD, dermatologists can perform patch testing which will confirm the diagnosis and, with a good clinical history, determine the allergen causing the rash.
—Atopic Dermatitis (AD):
Atopic dermatitis is the triad of atopic dermatitis (eczema), seasonal allergies, and asthma. 90-95% of people with AD will have the above triad by 5 years of age.
Those patients with atopic dermatitis are at an increased risk of irritant contact dermatitis due a defect in the barrier function of the skin, making it easier for irritants to cause rash.
Does frequent hand washing cause dry skin?
Yes, frequent hand washing does cause dry skin. As I discussed above, frequent hand washing causes removal of water-retaining substances of the skin, which will cause more inflammation and dry skin.
However, during the coronavirus pandemic, it is more important than ever to keep your hands clean!
I recommend using an alcohol-based hand sanitizer instead of soap and water if you struggle with dry skin on the hands. When you do use soap and water, it is best to use a fragrance-free gentle soap such as Dove, and lukewarm rather than hot water.
Is hand sanitizer a better way to sanitize to prevent dry skin?
Although soap and water may be more effective at removing chemicals and bacteria/viruses, hand sanitizers will cause LESS hand dermatitis than soap and water.
Therefore, I recommend using hand sanitizer with 60% alcohol to keep your hands free of viruses and bacteria. In addition, some hand sanitizers have aloe within their product which can help moisturize the skin.
If your hands are very greasy or dirty, hand sanitizer will not penetrate, and soap and water will be needed to remove dirt/grease.
What tips do you have for treating and preventing dry skin?
A gentle skin care routine can help to prevent dry skin. This may include limiting use of hot water when washing/bathing, using gentle fragrance-free soaps, and liberal use of topical moisturizers. It is best to use a hand moisturizer multiple times per day.
Thick ointments can be great for keeping water within the skin, however most people do not like having a greasy substance on their hands. Therefore, I recommend using a fragrance-free moisturizer cream, which usually comes in a jar or a tube, rather than a lotion which usually comes in a pump bottle.
Moisturizers should be applied multiple times per day, especially in the winter months.
When should I see a dermatologist for hand dermatitis?
If you notice that you are performing the above gentle skincare routine and you are still symptomatic, meaning burning, itching, dry, and cracked hands, you should come see a dermatologist! Dermatologists can help to further diagnose the cause of your hand dermatitis and recommend appropriate prescription treatments.
Sometimes, hand dermatitis can be caused by psoriasis or even infection such as superficial fungal infections. Dermatologists are trained to identify the subtle differences in various causes of hand dermatitis and recommend the corresponding treatment. Treatments may consist of creams/ointments, patch testing, and avoidance of the allergen, oral medications, biologic injections, and or/narrow-band ultraviolet light treatment.
The bottom line is- if your skin is interfering with your day in any way, book an appointment because it’s time to come visit us at Apex Dermatology!
Dr. Stecker is originally from Cleveland, Ohio. She completed her undergraduate training at the University of Miami where she majored in biology and English and received a presidential scholarship. She then attended Ohio University Heritage College of Osteopathic Medicine and graduated with honors.
She completed her dermatology-focused traditional internship at University Hospitals Regional Hospitals and served as internship chief resident. She then completed her dermatology residency at University Hospitals Cleveland Medical Center, where she was appointed academic chief resident. During her residency, Dr. Stecker was elected to the American Council for Graduate Medical Education dermatology review committee board, where she reviewed residency applications at a national level. Her research focused on patient education through enhancement of the electronic medical record. Upon graduation, she received the department of dermatology Quality Improvement award for her research.