Effect of glove occlusion on the skin barrier

Strategies in surface engineering for the regulation of microclimates in skin-medical product interactions

There is a growing number of personal healthcare devices that are in prolonged contact with the skin. The functionality of these products is linked to the interface formed by the contact between the medical apparatus and the skin. The interface can be characterised by its topology, compliance, and moisture and thermal regulating capabilities. Many devices are, however, described to have suboptimal and occlusive contacts, resulting in physiological unfavourable microclimates at the interface. The resulting poor management of moisture and temperature can impact the functionality and utility of the device and, in severe cases, lead to physical harm to the user. Being able to control the microclimate is therefore expected to limit medical-device related injuries and prevent associated skin complications. Surface engineering can modify and potentially enhance the regulation of the microclimate factors surrounding the interface between a product's surface and the skin. This review provides an overview of potential engineering solutions considering the needs for, and influences on, regulation of temperature and moisture by considering the skin-medical device interface as a system. These findings serve as a platform for the anticipated progress in the role of surface engineering for skin-device microclimate regulation.

Evaluation of Skin Barrier Condition Among Physicians and Dentists

Background: Physicians and dentists are at risk for chronic hand eczema, but their skin barrier condition has rarely been investigated before. Objective: To objectively assess the skin barrier condition among physicians and dentists. Methods: This cross-sectional epidemiological study included an occupational questionnaire, medical examination of hand skin, skin transepidermal water loss (TEWL), and pH measurements, analyzed in 5 groups (N = 37 in each): physicians-nonsurgeons, physicians-surgeons, dentists-nonsurgeons, dentists-surgeons, and control group (unexposed workers). Results: Critical skin condition (TEWL >30 g/[m2·h]) was found in 14% of control workers, 14% physicians nonsurgeons, 22% physicians surgeons, 27% dentists nonsurgeons, and 43% dentists surgeons. The latter had the worst stratum corneum condition indicated by a TEWL median of 25.80 g/(m2·h) (interquartile range [IQR] 19.24-34.31). Hand skin pH was highest among dentists with nonsurgical specializations, with a median of 5.33 (IQR 5.15-5.60), where 38% of them had pH >5.5. Male sex (P < 0.001) and glove use for >1 h/day (P = 0.009) were associated with elevated hand TEWL values, whereas female sex (P < 0.001) and glove use for >4 h/day with elevated pH values (P < 0.001). Conclusions: Prolonged glove usage and dental profession, especially surgical work, significantly affect the skin barrier condition. This study was the first to objectively determine skin barrier condition among dentists and physicians.

A Skin Care Program to Prevent Skin Problems due to Diabetes Devices in Children and Adolescents: A Cluster-Controlled Intervention Study

OBJECTIVE

Diabetes devices that deliver insulin and measure blood glucose levels are cornerstones in modern treatment of type 1 diabetes. However, their use is frequently associated with the development of skin problems, particularly eczema and wounds. Proper skin care may prevent skin problems, yet evidence-based information from interventional studies is missing. Providing this information is the aim of this study.

RESEARCH DESIGN AND METHODS

This cluster-controlled intervention study tested the efficacy of a basic skin care program (including use of lipid cream, removal, and avoidance of disinfection). A total of 170 children and adolescents with type 1 diabetes were included and assigned either to the intervention group (n = 112) or the control group (n = 58). Participants were seen quarterly the first year after device initiation, with clinical assessment and interview in an unblinded setting.

RESULTS

Eczema or wounds were observed in 33.6% of the intervention group compared with 46.6% of control participants (absolute difference, 12.9% [95% CI -28.7%, 2.9%]; P = 0.10). The adjusted odds of wound development were decreased by 71% in the intervention compared with control group (for wounds, odds ratio 0.29 [95% CI 0.12, 0.68]; P = 0.005). In total, only eight infections were seen, without a higher frequency in the intervention group, despite advice to omit disinfection.

CONCLUSIONS

These data indicate our basic skin care program partially prevented diabetes device-induced skin reactions. However, more preventive strategies with other adhesives, patches, and/or types of lotions are needed for optimized prevention.

S2k-Leitlinie Diagnostik, Prävention und Therapie des Handekzems: S2k guideline diagnosis, prevention and therapy of hand eczema

Die S2k‐Leitlinie „Diagnostik, Prävention und Therapie des Handekzems (HE)“ gibt auf der Grundlage eines evidenz‐ und konsensbasierten Ansatzes konkrete Handlungsanweisungen und Empfehlungen für die Diagnostik, Prävention und Therapie des HE. Die Leitlinie wurde auf der Grundlage der deutschen Leitlinie „Management von Handekzemen“ aus dem Jahr 2009 und der aktuellen Leitlinie der European Society of Contact Dermatitis (ESCD) „Guidelines for diagnosis, prevention and treatment of hand eczema“ aus dem Jahr 2022 erstellt. Allgemeines Ziel der Leitlinie ist es, Dermatologen und Allergologen in der Praxis und Klinik eine akzeptierte, evidenzbasierte Entscheidungshilfe für die Auswahl sowie Durchführung einer geeigneten und suffizienten Therapie für Patienten mit Handekzemen zur Verfügung zu stellen. Die Leitlinie basiert auf zwei Cochrane‐Reviews zu therapeutischen und präventiven Interventionen beim HE. Die übrigen Kapitel wurden überwiegend basierend auf nicht systematischen Literaturrecherchen durch die Expertengruppe erarbeitet und konsentiert. Die Expertenkommission bestand aus Mitgliedern von allergologischen und berufsdermatologischen Fachgesellschaften und Arbeitsgruppen, einer Patientenvertretung und Methodikern. Im Rahmen einer Konsensuskonferenz am 15.09.2022 wurden die Vorschläge für die Empfehlungen und Kernaussagen unter Verwendung eines nominalen Gruppenprozesses konsentiert. Der strukturierte Konsensfindungsprozess wurde professionell moderiert. Die vorliegende Leitlinie hat eine Gültigkeit bis zum 22.02.2028.

S2k guideline diagnosis, prevention, and therapy of hand eczema

The consensus-based guideline "Diagnosis, prevention, and treatment of hand eczema (HE)" provides concrete instructions and recommendations for diagnosis, prevention, and therapy of HE based on an evidence- and consensus-based approach. The guideline was created based on the German guideline "Management von Handekzemen" from 2009 and the current guideline of the European Society of Contact Dermatitis (ESCD) "Guidelines for diagnosis, prevention, and treatment of hand eczema" from 2022. The general goal of the guideline is to provide dermatologists and allergologists in practice and clinics with an accepted, evidence-based decision-making tool for selecting and conducting suitable and sufficient therapy for patients with hand eczema. The guideline is based on two Cochrane reviews of therapeutic and preventive interventions for HE. The remaining chapters were mainly developed and consented based on non-systematic literature research by the expert group. The expert group consisted of members of allergological and occupational dermatological professional associations and working groups, a patient representative, and methodologists. The proposals for recommendations and key statements were consented by using a nominal group process during a consensus conference on September 15, 2022. The structured consensus-building process was professionally moderated. This guideline is valid until February 22, 2028.

Glove-Induced Hand Dermatitis: A Study in Healthcare Workers during COVID-19 Pandemic in Indonesia

Skin damage among healthcare workers has been reported by many centers around the world. Occupational hand dermatitis is one of the most commonly known occupational skin diseases and a socially significant health issue. The use of gloves is one of the risk factors for the occurrence and/or aggravation of hand dermatitis. This cross-sectional study involved healthcare workers in 14 referral hospitals for COVID-19 throughout Indonesia. Questionnaires were distributed to the participants, which consisted of the subject's characteristics, glove-related skin problems, history of glove use, and clinical history. This study involved a total of 845 healthcare workers. Approximately 156 healthcare workers (18.46%) had glove-induced hand dermatitis during the pandemic. Itchy skin was the most common symptom (44.23%), and the palm was the most frequently complained area (48.72%). There was a significant association between glove use and glove-induced hand dermatitis among healthcare workers. In particular, equal to or more than 2 hours per day of glove use was significantly associated with hand dermatitis. Glove-induced hand dermatitis also had a significant association with the subject's history of atopic dermatitis and previous history of hand dermatitis. The use of gloves by healthcare workers should be considered carefully, especially in individuals at increased risk, including those who use gloves for 2 hours or more per day and those who have a history of atopic or hand dermatitis, in order to prevent the incidence of glove-induced hand dermatitis among healthcare workers, as well as to provide a safe working environment.

Effects of impermeable and semipermeable glove materials on resolution of inflammation and epidermal barrier impairment after experimental skin irritation

BACKGROUND

Semipermeable membranes might be suitable for glove liners or comfort gloves in individuals with irritant contact dermatitis (ICD).

OBJECTIVES

To evaluate the effects of different glove materials on inflammation and epidermal barrier impairment after experimental skin irritation.

METHODS

Nine test areas on the volar forearms of 24 healthy volunteers were irritated with sodium lauryl sulfate (1%) and afterward covered for 6 days (6 or 8 h/day) with semipermeable Sympatex (SYM), vinyl (OCC), combinations of vinyl with Sympatex (SYM/OCC) or cotton (COT/OCC), or left uncovered (CON). Up to day 10, measurements of transepidermal water loss (TEWL), erythema (a*), skin humidity (SH) and visual scoring (VS) were applied.

RESULTS

No significant differences in skin parameters were found between COT/OCC and SYM/OCC as well as between each of the combinations and CON. SYM, COT/OCC and SYM/OCC led to better results for most skin parameters than OCC alone.

CONCLUSIONS

Occlusive material has a negative impact on skin barrier recovery and inflammation after skin irritation whereas SYM is not inferior to uncovered areas indicating good tolerability. Altogether, the data suggest that SYM is a useful alternative to COT as material for glove liners and comfort gloves in ICD patients.

What do professional cleaners know about the skin care? A questionnaire-based study

BACKGROUND

Correct daily skin care is important regarding hand eczema (HE). However, only a few studies have evaluated the level of knowledge among hospital cleaners.

OBJECTIVE

To examine the level of knowledge regarding skin protective behaviour and risk factors with respect to HE in hospital cleaners.

METHODS

All cleaners working in four hospitals in Denmark were invited to participate in the study, which was based on a questionnaire consisting of 22 questions.

RESULTS

142 of 236 cleaners (response rate = 60.1%) were included. The mean of total correct answers were approximately five out of nine questions. 85.6% of participants evaluated themselves to have a low degree of knowledge of skin care and protection. Based on the number of correct answers, 90% were defined as having low knowledge. Being born or raised outside of Denmark was statistically significantly associated with lower level of knowledge. Risk factors for HE such as, work with wet hands, and use of household cleaning products were only recognized as risk factors by less than 50%.

CONCLUSION

Our study indicates that Danish hospital cleaners have a low degree of knowledge regarding skin care and protection. Cleaning workers born or raised outside of Denmark are in need of special attention.

Applying skin protective cream and the wearing of gloves?-A randomized controlled experimental study

BACKGROUND

Glove occlusion might enhance skin sensitivity to a subsequent detergent challenge (occlusion effect). Thus, some skin protection creams (PC) claim to protect against this effect of occlusion, and are recommended to be used before wearing liquid-proof gloves.

OBJECTIVES

To evaluate the effect of PC applied prior to glove occlusion on the 'occlusion effect'-refers to increased susceptibility of the skin to a model detergent.

METHODS

One hundred and eleven volunteers were enrolled in a single-blind, randomized study. Seven PCs were applied before glove occlusion over 7 days (D1-D7). After sodium lauryl sulphate (SLS) challenge, we compared the irritation between the areas treated with PC and occlusion alone. Clinical scoring and bioengineering methods (capacitance, transepidermal water loss [TEWL], and colourimetry [erythema]) were used to quantify the irritant reactions.

RESULTS

After 1 week of occlusion and PC application, we did not observe significant changes in TEWL, nor in erythema, whereas skin hydration raised in three cream-treated areas. On day 10, after a challenge with SLS, some products significantly aggravated the skin irritation as compared to occlusion alone.

CONCLUSIONS

The 'occlusion effect'-shown as higher skin susceptibility to a model detergent-was not mitigated by PCs when applied prior to glove occlusion. On the contrary, some PCs might have negative effects on skin barrier function and augment such sensitivity.

Effects of ultra-pure soft water on the hands of nurses in a neonatal intensive care unit: A randomized crossover study

BACKGROUND

Healthcare workers (HCWs) wash their hands with tap water (TW) and soap. However, hard TW causes dermatitis.

OBJECTIVES

The present study aimed to compare the effects of ultra-pure soft water (UPSW) with those of TW on the hands of HWCs.

METHODS

The present study was a prospective randomized trial with a crossover design. All the nurses in the neonatal intensive care unit (NICU) at the study centre were divided into Sequence 1 (UPSW to TW) or 2 (TW to UPSW) and washed their hands with TW or UPSW in alternating 4-week periods with a 4-week washout period. Trans-epidermal water loss (TEWL) and stratum corneum hydration (SCH) were evaluated. Skin condition was self-assessed.

RESULTS

Twenty-one and 22 nurses were assigned to Sequence 1 and Sequence 2, respectively. USPW increased SCH to a significantly greater degree than TW (mean: 26.3 μS ± 12.3 SD; 95% confidence interval: 1.12-51.54; p = 0.041) although it did not affect TEWL. UPSW use significantly improved the subjects' skin condition, as reflected in an overall increase in the assessment scores.

CONCLUSIONS

UPSW improved SCH and the condition of hand skin. Prolonged USPW use may increase nurses' comfort during work and hand hygiene compliance.

Effects and acceptance of semipermeable gloves compared to cotton gloves in patients with hand dermatoses: Results of a controlled intervention study

BACKGROUND

Semipermeable gloves might be an alternative to cotton gloves in management of hand dermatoses.

OBJECTIVES

To compare acceptance and tolerability of gloves made of cotton or a semipermeable Sympatex membrane in patients with hand dermatoses and their effect on skin lesions when worn overnight.

METHODS

199 patients with work-related symmetrical hand dermatoses were asked to wear a cotton glove (COT) on one hand and a Sympatex glove underneath a cotton glove (SYM/COT) on the other hand for nineteen consecutive nights. The severity of skin lesions was regularly examined. A questionnaire on acceptance and tolerability was used in a subset of 126 patients.

RESULTS

Data on skin lesions were available for 183 participating patients (92%). The severity did not differ substantially between hands covered with SYM/COT or COT over time. Questionnaire data were available for 120 patients (95%). SYM/COT received better ratings regarding climate conditions while COT showed superiority in wearing comfort, practicality and appearance.

CONCLUSIONS

Both SYM/COT and COT were well tolerated and accepted in patients with hand dermatoses. Hence, SYM/COT may serve as suitable alternative for COT as comfort gloves supporting therapeutic efforts. The observed slight differences may influence the decision when selecting the glove type. This article is protected by copyright. All rights reserved.

Skin barrier function in nursing apprentices during the COVID-19 pandemic

Background

Studies investigating simultaneous influence of personal and work‐related factors on skin health during the coronavirus disease 2019 (COVID‐19) pandemic are missing.

Objectives

To investigate the associations of skin hazards relevant for nursing apprentices with parameters of skin barrier function.

Methods

A total of 238 nursing apprentices attending the final year of education (median age 19 years) from vocational schools in Zagreb, Croatia, were enrolled in this study. We administered a questionnaire based on the Nordic Occupational Skin Questionnaire to the nursing apprentices, performed clinical examination of skin on the hands, and evaluated transepidermal water loss (TEWL) and stratum corneum (SC) pH on the dorsum of the hand.

Results

Around half of nursing apprentices had compromised hand skin barrier function, as indicated by TEWL values >25 g/m²/h (48%) and SC pH >5.5 (57%). Skin barrier was compromised in around 40% of nursing apprentices without clinically observed skin symptoms. Elevated SC pH was independent of ambient conditions associated with skin symptoms and female sex.

Conclusions

Measurement of SC pH was shown to be less sensitive to field conditions than TEWL, and should be employed more in the field studies. Strengthening of skin health promotion in healthcare workers and apprentices is needed in pandemic conditions.

The Dermatological Effects and Occupational Impacts of Personal Protective Equipment on a Large Sample of Healthcare Workers During the COVID-19 Pandemic

Introduction

Working during the Sars-CoV-2 pandemic healthcare workers (HCWs) had to wear Personal Protective Equipment (PPEs) for extended periods of time, leading to an increase in dermatological reactions. The study evaluates the prevalence of adverse skin reactions to PPEs among Italian healthcare workers during the COVID-19 pandemic, and aims to determine whether prolonged PPEs usage poses a significant occupational health risk, by measuring the loss of work days and the eligibility of workers that requested health surveillance due to dermatological PPEs reactions.

Materials and Methods

An online ad hoc questionnaire was administered to a sample of Italian HCWs. Questions verted on sociodemographic characteristics, PPEs usage, and occupational well-being. Descriptive analyses and logistic regressions were performed to explore possible associations between variables.

Results

Two types of PPEs, Gloves and Masks, were tested. The sample included 1,223 interviewed HCWs, 1,184 gave their consent for participation. A total of 90 medical surveillance visits were requested due to PPEs related dermatological issues: in 30 cases were recognized limitations in working duties and in one case the worker was deemed not fit to keep working. Furthermore, 25 workers had a loss of occupational days due to dermatological issues. A statistically significant correlation was observed with being a nurse or midwife (OR = 1.91, IC = 1.38–2.63, p < 0.001), and being female (OR = 2.04, IC = 1.49–2.78, p < 0.001), which acted as risk factors.

Discussion

The enhanced protection measures put in place during the COVID-19 pandemic, highlight the importance of occupational dermatology. This study could contribute to assess the issue, aiming to develop better prevention strategies in the workplace in order to improve well-being of HCWs and reduce the impact of dermatological adverse reactions to PPEs.

Assessment of Hygiene Indicators When Using Gloves by Transport Workers in Russia during the COVID-19 Pandemic

The COVID-19 outbreak represents a global public health emergency. National governments have gradually introduced restrictive measures. Using respiratory protective equipment (face masks) and gloves was essential practice without specific infection control measures or guidelines. This study aimed to assess hygiene indicators when using gloves by transport workers in Russia during the COVID-19 pandemic and to develop integral indicators and recommendations for wearing gloves for workers for whom this is a mandatory requirement. For this purpose, 1103 transport workers were surveyed using a questionnaire. We investigated the hygiene aspects of gloves and evaluated the bacterial contamination of the contact side of the gloves based on the wash results. We assessed the socio-demographic characteristics of the respondents, the duration of the work shift, the frequency of use of types of gloves, skin manifestations, the degree of comfort, and bacterial growth. We carried out the ranking according to comfort, the absence of adverse dermatological reactions when wearing gloves, and bacterial contamination of the inner surface of the gloves. It has been identified that it is necessary to use a comprehensive assessment of gloves to create a register of protective equipment, taking into account the frequency with which it was worn, the severity of the skin condition, comfort, and bacterial contamination.

Causes of irritant contact dermatitis after occupational skin exposure: a systematic review

PURPOSE

Irritant contact dermatitis (ICD) is a major cause of occupational disease. The aim was to review the relation between exposure to occupational irritants and ICD and the prognosis of ICD.

METHODS

Through a systematic search, 1516 titles were identified, and 48 studies were included in the systematic review.

RESULTS

We found that the evidence for an association between ICD and occupational irritants was strong for wet work, moderate for detergents and non-alcoholic disinfectants, and strong for a combination. The highest quality studies provided limited evidence for an association with use of occlusive gloves without other exposures and moderate evidence with simultaneous exposure to other wet work irritants. The evidence for an association between minor ICD and exposure to metalworking fluids was moderate. Regarding mechanical exposures, the literature was scarce and the evidence limited. We found that the prognosis for complete healing of ICD is poor, but improves after decrease of exposure through change of occupation or work tasks. There was no substantial evidence for an influence of gender, age, or household exposures. Inclusion of atopic dermatitis in the analysis did not alter the risk of ICD. Studies were at risk of bias, mainly due to selection and misclassification of exposure and outcome. This may have attenuated the results.

CONCLUSION

This review reports strong evidence for an association between ICD and a combination of exposure to wet work and non-alcoholic disinfectants, moderate for metalworking fluids, limited for mechanical and glove exposure, and a strong evidence for a poor prognosis of ICD.

An update on the prevalence and risk exposures associated with hand eczema in Danish hospital employees: A cross-sectional questionnaire-based study

BACKGROUND

Hand eczema (HE) is common in health care workers (HCWs). During the last decade, new recommendations have supported increased use of alcohol-based hand rub (ABHR) to partially replace hand washings to lower the prevalence of HE. However, newer data on this recommendation is lacking.

OBJECTIVES

To assess current 1-year prevalence of HE in HCWs, to investigate exposure, and the extent of subjective discomfort to hand washings and ABHR.

METHODS

A digital questionnaire was sent to 4876 HCWs from April to May 2020.

RESULTS

Of 2125 respondents (1779 women, 346 men), 14.7% reported HE within the last year. In total, 9.1% reported >20 hand washings per shift and 76.0% reported ABHR use >20 times per shift. HE was significantly associated with hand washings (adjusted odds ratio [OR] 1.73 [95% confidence interval [CI] 1.26-2.36]) and glove use on wet skin (adjusted OR 1.99 [95% CI 1.27-3.12]). Subjective discomfort to ABHR was reported significantly more often than to hand washings (P < .001) and significantly more often in HCWs with HE than in those without HE (P < .001).

CONCLUSIONS

The current 1-year HE prevalence in HCWs of 14.7% was lower than in previously reported Scandinavian data. HE was related to frequent hand washings, as previously reported, and to glove use on wet skin, which is a possible risk factor for HE that should be further explored.

Acceptance of semipermeable glove liners compared to cotton glove liners in health care workers with work-related skin diseases: Results of a quasi-randomized trial under real workplace conditions

BACKGROUND

Glove liners (GLs) made of cotton (COT) are worn under impermeable gloves to prevent occlusion effects. Semipermeable GLs made of Sympatex (SYM) might be an alternative.

OBJECTIVES

To evaluate the acceptance of GLs (COT/SYM) in health care workers (HCWs) with work-related skin diseases (WRSDs).

METHODS

One hundred sixty-one HCWs with WRSDs were asked to wear GLs in combination with occlusive gloves for 10 ±2 weeks under workplace conditions. A questionnaire was applied to compare acceptance and usability of the respective glove combinations and previously used protective gloves (PUGs).

RESULTS

A total of 120 data sets were available (SYM: n = 65, 77.4%; COT: n = 55, 71.4%). Both GLs provided a significantly lower sweating sensation, more pleasant climate, comfortable wearing experience, and moist or dry feeling on the skin compared to PUGs. SYM-GLs performed significantly better than COT-GLs regarding mobility of hands, sensitivity, and sense of touch. COT-GLs were significantly better than SYM-GLs in the categories fit, donning and doffing, and material contact.

CONCLUSIONS

Both GLs did not impair work performance, were applicable in various areas of health care activities, and were preferred over PUGs. Our results indicate that SYM-GLs are an alternative to COT-GLs and thus may contribute to current prevention strategies.

Hand Dermatitis in the Time of COVID-19: A Review of Occupational Irritant Contact Dermatitis

Occupational contact dermatitis accounts for 95% of all cases of occupational skin disease with irritant contact dermatitis (ICD) constituting 80% to 90% of these cases. Health care workers, hairdressers, and food service workers are typically most affected by occupational ICD of the hands as these occupations require frequent hand hygiene and/or prolonged exposure to water, also known as "wet work." In the context of the current COVID-19 pandemic, frequent hand hygiene has become a global recommendation for all individuals, and new workplace guidelines for hand sanitization and surface sterilization are affecting occupations not previously considered at risk of excessive wet work including grocery or retail workers, postal workers, sanitization workers, and others. In this review, we discuss the etiology and pathogenesis of occupational ICD with additional focus on treatment and interventions that can be made at an institutional and even national level for education and prevention of ICD resulting from frequent hand hygiene.

The Prevalence and Determinants of Hand and Face Dermatitis during COVID-19 Pandemic: A Population-Based Survey

BACKGROUND

During the current COVID-19 pandemic, prevention is the key to limiting the spread of this disease. The frequent handwashing and use of sanitizers resulted in notable skin changes among some individuals. The aim of the study was to determine the prevalence and determinants of the new onset of dermatitis during the COVID-19 pandemic in a university population from Saudi Arabia.

METHODS

A cross-sectional study was conducted using a self-administered online questionnaire by sending an invitation link to students and employees of Prince Sattam Bin Abdulaziz University in June 2020. A chi-squared test was used to note differences regarding hand and face dermatitis.

RESULTS

Of the total 2356 participants, 34.8% reported skin changes or symptoms over hands, and 15.3% reported skin changes on their face during this pandemic. 88.7% of the participants reported a change in handwashing habits during the COVID-19 pandemic, and 62.2% of participants were not using any hand sanitizers before COVID-19 but began using them during the pandemic. There were significantly higher percentage of skin conditions in females (on hands (ScH): 42.6% and face (ScF):19.2%), individuals working in environments requiring frequent handwashing (ScH: 40.3% vs. ScF: 17.2%), those working in facilities where they have to interact with people during the pandemic (ScH: 41.1% vs. ScF: 18.7%), those encountering COVID-19 patients (ScH: 48.6% vs. ScF: 24.8%), those exposed to chemicals (ScH: 48.6% vs. ScF: 24.8%), and healthcare workers (ScH: 51.3% vs. ScF: 24.3%).

CONCLUSION

It was found that during the pandemic, skin changes were common among the general population as well as among healthcare workers. The frequency of handwashing and the use of alcohol-based sanitizers were contributing factors for dermatitis. Although hygiene is an extremely important preventive measure in this pandemic, maintaining skin integrity is also vital. Appropriate knowledge and good practice can prevent dermatitis in this pandemic, with regular hydration of the skin being a key factor.

Prevención de lesiones cutáneas causadas por productos y equipos de protección personal durante COVID-19: revisión de alcance

Sinopsis

Objetivo:

Identificar, resumir y presentar las recomendaciones publicadas para prevenir lesiones cutáneas (cualquier alteración de la piel) por el uso de productos y equipos de protección personal (EPP) en profesionales de la salud durante la pandemia del COVID-19.

Método:

Se realizó una revisión de alcance, basada en las sugerencias del Instituto Joanna Briggs, entre diciembre de 2019 y mayo de 2020. Se incluyeron estudios realizados con profesionales de la salud de ambos sexos, que utilizaron productos y EPP durante la pandemia, en cualquier escenario de la atención sanitaria. Se examinaron los títulos y resúmenes de los estudios. Dos revisores independientes evaluaron el texto completo, según los criterios de inclusión establecidos.

Resultados:

Ocho publicaciones fueron seleccionadas. Todas se centraron en los cuidados relacionados con la prevención de lesiones por presión (LPP). Resaltaron la higiene e hidratación, y el uso de protectores cutáneos como medidas preventivas.

Conclusión:

Es necesario llevar a cabo investigaciones en busca de mejores estrategias para mantener la integridad de la piel de los profesionales de la salud en el ejercicio de su profesión durante el COVID-19.

Conflicto de interés:

Este artículo es parte de un proyecto apoyado por el Ministerio de Ciencia, Tecnología e Innovaciones (MCTI) y el Consejo Nacional de Desarrollo Científico y Tecnológico (CNPq) de Brasil.

COVID-19 and hand hygiene: the vital importance of hand drying

The significance of hand hygiene for preventing the transmission of microorganisms and reducing the spread of infection has been brought into sharp focus following the global coronavirus (COVID-19) pandemic. In the months since the initial outbreak, international public health campaigns and practitioner education has concentrated on hand washing and hand sanitising, with very little reference to hand drying, if any at all. However, hand drying is integral to effective hand hygiene, and is important in controlling the spread of microorganisms and maintaining healthy skin integrity. This research commentary will focus on two issues of importance with regards to hand drying: microbial transmission and skin irritation, with implications for healthcare practitioners and practice considered. It is argued that a more holistic approach to hand hygiene must be the ambition if health professional and public behaviour is to become embedded and sustained.

Use of protective gloves by hairdressers: A review of efficacy and potential adverse effects

Occupational hand eczema is common among hairdressers, and protective gloves are important in limiting exposure to irritants and allergens. Various glove types may differ in their protective ability, and their use may lead to hand eczema due to skin irritancy and allergy. MEDLINE was searched for studies investigating permeation of gloves to irritants and allergens used in the hairdressing trade, as well as adverse effects of glove use affecting hairdressers. Forty-four studies were identified; nine reported on permeation. Of those, two in vitro studies found nitrile rubber (NR) gloves to give the best protection when handling hair dyes. Polyethylene (PE) gloves had the lowest reported break-through time. The prevalence of sensitization to rubber materials in European hairdressers was as follows: thiuram mix, median 2.5% (range 0%-8.2%), weighted average 3.0% (95% confidence interval [CI] 3.0%-3.1%); mercapto mix, median 0.4% (range 0%-3.3%), weighted average 0.5% (95% CI 0.47%-0.50%), mercaptobenzothiazole, median 0.6% (range 0%-6.6%), weighted average 0.7% (95% CI 0.6%-0.7%), NRL-type I allergy, median 1.3% (range 1%-16.4%), weighted average 4.0% (95% CI 3.6%-4.5%). In conclusion, NR gloves provide the best skin protection for hairdressers, although natural rubber latex (NRL) and polyvinylchloride (PVC) gloves may be sufficient in most cases. PE gloves are not recommended. Synthetic rubber gloves with low or no levels of accelerators are preferred.

Skin barrier function after repeated short-term application of alcohol-based hand rub following intervention with water immersion or occlusion

BACKGROUND

Alcohol-based hand rub (ABHR) is recommended for hand hygiene, and application on dry skin is generally well tolerated. However, hydration of the skin may lead to increased susceptibility to ABHR.

OBJECTIVES

To evaluate if increased skin hydration changes skin barrier response to ABHR, as compared to application on dry skin.

METHODS

Twenty healthy volunteers participated in a 3-day experimental setup. Intervention areas on the forearms were exposed to either water immersion or occlusion followed by repeated exposures to ABHR. Skin barrier function was assessed by measurement of transepidermal water loss (TEWL), electrical conductance, pH, and erythema at baseline and day 3.

RESULTS

The area exposed to water immersion preceding ABHR showed a significant increase in TEWL from baseline to day 3 (P = .04), and for the occluded area the same trend was found (P = .11), with an additional decrease in electrical conductance (P = .03). No significant differences were found for the control area. The assessments did not differ significantly between intervention and control sites.

CONCLUSION

Our results indicate that extensive skin hydration may lead to increased susceptibility to ABHR. Further evaluation of this observation is important, since ABHRs are widely used, particularly among health care workers in whom hand eczema is a huge problem.

Work-related skin symptoms among Bulgarian dentists

BACKGROUND

Dentists are at high risk of developing skin symptoms due to occupational contact with irritants and/or allergens.

OBJECTIVES

To assess the point prevalence of work-related skin symptoms and associated factors in Bulgarian dentists.

METHODS

A cross-sectional study was performed using a self-report questionnaire.

RESULTS

A total of 4675 dentists filled the questionnaire (response 48.1%). The point prevalence of self-reported skin symptoms was 31.6%. According to logistic regression analysis, factors significantly associated with work-related skin symptoms included a personal history of atopic dermatitis (odds ratio [OR] 2.72, 95% confidence interval [CI]: 2.24-3.31), allergic rhinoconjunctivitis and/or asthma (OR 1.85, 95%CI: 1.56-2.19), work experience >30 years (OR 2.21, 95%CI: 1.78-2.74), personal history of contact allergy (OR 1.79, 95%CI: 1.48-2.17), female sex (OR 1.87, 95%CI: 1.59-2.19), hand washing >8 times a day (OR 1.32, 95%CI: 1.03-1.69), daily contact ≥4 hours with protective gloves (OR 2.09, 95%CI: 1.64-2.67), and use >10 pairs of gloves per day (OR 1.51, 95%CI: 1.11-2.04).

CONCLUSION

Bulgarian dentists have a high prevalence of work-related skin symptoms. History of atopic dermatitis, prolonged work experience, and protective gloves use were the strongest risk factors.

Skin Barrier Impairment due to the Occlusive Effect of Firefighter Clothing

At fire scenes, firefighters are exposed to potentially harmful substances. Besides inhalation of these products, also skin contamination and the risk of dermal absorption is getting more attention. In this perspective, skin barrier impairment due to the occlusive effect of firefighter clothes could enhance the risk of penetration of hazardous substances. The effect of a firefighter jacket and cellophane on the skin was studied in a paired comparison involving 16 volunteers. Biophysical parameters were measured before, immediately after and 30 min after ending the occlusion. Reflectance confocal microscopy was used to study the skin morphology. Immediately after wearing a firefighter jacket, Transepidermal Water Loss values were significantly increased. This is an indication of an occlusive effect of the firefighter jacket. The skin barrier was fully restored after 30 min after occlusion with cellophane or wearing a firefighter jacket.

[Prevention of hand eczema]

Apart from endogenous factors, hand eczema is often caused by irritant or allergic contact dermatitis related to occupational or non-occupational exposure to skin hazards. This enables several complementary approaches on the level of primary, secondary and tertiary prevention. A high priority is set on identification and subsequent reduction or elimination of causative exposures. Important preventive approaches include legal regulations, technical and organizational measures as well as correct use of adequate personal protective equipment (e.g. protective gloves). Interventions based on health education are conducted to improve individual protective behaviour. Even though evidence-based proof of effectiveness is limited, preventive measures are considered of particular importance for avoidance of occupational hand eczema and its adverse sequelae. Therefore, a complex, step-wise approach to occupational skin diseases has been established in Germany. In recent years, the positive impact of secondary and tertiary preventive measures of this approach has been demonstrated.

Skin reactions among Bulgarian dental students: A self-report questionnaire survey

BACKGROUND

Dental students are at high risk of developing adverse skin reactions following practical work during the dentistry degree program. They encounter multiple irritants and allergens that may cause skin reactions on exposed parts of the body, notably the hands.

OBJECTIVES

To estimate the prevalence of skin reactions related to the pre-clinical and clinical training courses of the dentistry program and associated risk factors in Bulgarian dental students.

METHOD

A cross-sectional study was performed using a self-report questionnaire.

RESULTS

A total of 467 dental students completed the questionnaire (response 51.8%). The prevalence of self-reported skin symptoms was 21.2%. According to logistic regression analysis, the most important risk factors for work-related skin symptoms were a personal history of atopic dermatitis (odds ratio [OR] 3.92, 95% confidence interval [CI]: 1.99-7.72), allergic rhinoconjunctivitis and/or asthma (OR 1.94, 95%CI: 1.03-3.68), personal history of contact allergy (OR 2.19, 95%CI: 1.06-4.55), and hand washing >16 times a day (OR 2.42, 95%CI: 1.06-5.52).

CONCLUSIONS

The results of this study suggest that work-related skin symptoms are frequent among dental students and indicate the need to establish effective primary preventive programs for occupational skin disorders at a national level.

Skin exposure to the rubber accelerator diphenylguanidine in medical gloves-An experimental study

BACKGROUND

Dermatitis caused by occupational contact allergy to rubber additives such as diphenylguanidine (DPG) in medical gloves is a hazard for healthcare workers. Both the duration of exposure to medical gloves and the number of gloves used per day vary. The use of alcoholic skin disinfectants before glove donning is mandatory.

OBJECTIVES

To assess whether skin exposure to the rubber accelerator DPG released from glove material is influenced by alcoholic hand disinfectants, time, and pH.

METHODS

With the use of ethanol washes, the amount of DPG left on the hands after wearing of gloves for 60 minutes was measured, and comparisons between hands exposed and not exposed to alcoholic disinfectant before glove donning were made. With the use of artificial sweat buffered at pH 4, 5, and 6, DPG release from the insides of gloves at different times was measured.

RESULTS

The use of alcoholic disinfectant prior to polyisoprene glove donning increased the amount of DPG recovered from the hands. Of the DPG released from polyisoprene gloves into artificial sweat, almost 84% was released within 10 minutes. pH did not influence the rate of release.

CONCLUSIONS

The use of alcoholic disinfectant increased skin exposure to the rubber accelerator DPG. Even a short duration of use of gloves results in substantial exposure to DPG.

Hand eczema and wet work: dose-response relationship and effect of leaving the profession

BACKGROUND

Wet work is an important risk factor for occupational hand eczema.

OBJECTIVES

To examine the effect of job change in workers with occupational hand eczema caused by wet work, and to evaluate the dose-response relationship between intensity of wet work and eczema.

METHOD

The study is based on a subgroup (n = 954) from a descriptive, registry-based study including all participants with occupational hand eczema caused by wet work recognized by the Danish Labour Market Insurance Authority in 2010 and 2011. A follow-up questionnaire was sent out 4-5 years later (response 58%).

RESULTS

Change of profession and being outside the labour market had a positive effect on healing and improvement of hand eczema. Inverse dose-response relationships were found between the amount of time spent with wet hands at work and healing (p = 0.001) and improvement (p < 0.001), and between the frequency of hand washing at work and healing (p = 0.013) and improvement (p < 0.001).

CONCLUSIONS

Leaving the profession has a positive effect on eczema; however, even minor changes in exposure to wet work were associated with healing and improvement. This information has implications with respect to advice given to patients with occupational hand eczema caused by wet work.