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

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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.

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.