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Prepared by: Josh Townley PhD
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?
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.
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]
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.
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]
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.
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;
