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Brief ReportBrief Report

What You Need to Know About Hand Hygiene and Dermatitis During the Coronavirus Pandemic

Arthur S. Nguyen, Brian V. Thielen, Paul L. Bigliardi and Ronda S. Farah
The Journal of the American Board of Family Medicine September 2021, 34 (5) 888-890; DOI: https://doi.org/10.3122/jabfm.2021.05.200648
Arthur S. Nguyen
the University of Minnesota Medical School, Minneapolis, MN (ASN, BVT, PLB, RSF); Department of Dermatology, University of Minnesota, Minneapolis, MN (PLB, RSF).
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Brian V. Thielen
the University of Minnesota Medical School, Minneapolis, MN (ASN, BVT, PLB, RSF); Department of Dermatology, University of Minnesota, Minneapolis, MN (PLB, RSF).
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Paul L. Bigliardi
the University of Minnesota Medical School, Minneapolis, MN (ASN, BVT, PLB, RSF); Department of Dermatology, University of Minnesota, Minneapolis, MN (PLB, RSF).
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Ronda S. Farah
the University of Minnesota Medical School, Minneapolis, MN (ASN, BVT, PLB, RSF); Department of Dermatology, University of Minnesota, Minneapolis, MN (PLB, RSF).
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    Figure 1.

    Representative photograph of irritant contact dermatitis (ICD) in a patient resulting from frequent handwashing.

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    Figure 2.

    Representative photograph of allergic contact dermatitis (ACD) in a patient undergoing patch testing to allergens found in rubber chemicals and polymerization catalysts used in the production process.

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    Table 1.

    Comparison Between Irritant Contact Dermatitis (ICD) and Allergic Contact Dermatitis (ACD)

    Irritant Contact Dermatitis (ICD)Allergic Contact Dermatitis (ACD)
    Clinical Manifestation
    • Xerosis

    • Erythema

    • Pruritus

    • Burning

    • Fissuring

    • Scaling

    • Lichenification

    • Mostly limited to site of exposure (Figure 1)

    • Erythema

    • Pruritus

    • Edema

    • Induration

    • Vesicles, bullae, crusting

    • Fissuring

    • Lichenification

    • Spreading over site of exposure (Figure 2)

    Pathophysiology
    • Non-immune response to repeated exposure to agents

    • Disrupted skin integrity

    • Loss of moisture and protective lipids

    • Immune-mediated response to allergens

    • Sensitization results in cell-mediated inflammatory cascade

    Causative Agents
    • Detergents

    • Disinfectants

    • ABHRs

    • Water

    • Fragrances

    • Often related to atopic predisposition

    • PPE (eg, gloves)

    • Latex

    • Rubber compounds

    • ABHRs

    • Fragrances

    • Propylene glycol

    • Any possible contact allergen

    Treatments
    • Avoidance of known irritants

    • Emollients

    • Keratolytics

    • Topical steroids

    • Avoidance of allergens

    • Emollients

    • Topical steroids

    • Modifications to occupation

    Diagnostic
    • Patch tests to rule out ACD (diagnosis by exclusion) with decrescendo reactions in patch tests*

    • Fungal culture (exclude Tinea)

    • Biopsy if suspicion for Psoriasis

    • Evaluation of atopy (history, spec IgE, prick tests)

    • Patch tests to find causative agents and allow allergen avoidance with crescendo reactions in patch tests*

    • PPE, personal protective equipment; ABHR, alcohol-based hand rub.

    • ↵* Decrescendo reactions mean that after 2 days (removal of patch tests), there is a slight reaction that disappears the next 2 days. Crescendo reactions mean that there is no or slight reaction at day 2 (removal of patches) followed by an increased reaction the next 2 days. This difference is why we need 2 readings to distinguish irritants from allergic reactions, which is particularly important in atopic individuals with a high risk for irritant reactions. Most patients with irritant hand dermatitis have an atopic predisposition.

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The Journal of the American Board of Family     Medicine: 34 (5)
The Journal of the American Board of Family Medicine
Vol. 34, Issue 5
September/October 2021
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What You Need to Know About Hand Hygiene and Dermatitis During the Coronavirus Pandemic
Arthur S. Nguyen, Brian V. Thielen, Paul L. Bigliardi, Ronda S. Farah
The Journal of the American Board of Family Medicine Sep 2021, 34 (5) 888-890; DOI: 10.3122/jabfm.2021.05.200648

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What You Need to Know About Hand Hygiene and Dermatitis During the Coronavirus Pandemic
Arthur S. Nguyen, Brian V. Thielen, Paul L. Bigliardi, Ronda S. Farah
The Journal of the American Board of Family Medicine Sep 2021, 34 (5) 888-890; DOI: 10.3122/jabfm.2021.05.200648
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  • COVID-19
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