Skin care in the era of COVID19

Prolonged use of PPE and frequent hand hygiene can result in skin damage. This can affect provider
morale, cause anxiety, and increase risk for infection 1. 97% of front line workers in China experienced
skin problems related to PPE and frequent hand hygiene 2.

Below are recommendations adapted from Consensus of Chinese experts on protection of skin and
mucous membrane barrier for healthcare workers fighting against coronavirus disease 2019

Proper hand cleansers & hygiene

 COVID shows low resistance to disinfectants: common hand soaps and hand sanitizers can
inactivate the virus. When washing with soap and water, 20 seconds is recommended, but
aggressive scrubbing is typically not necessary.

 Outside of work, foamless cleansing products (such as CeraVe hydrating cleanser, Cetaphil skin
cleanser, or other cream-based cleansers) containing moisturizing ingredients are
recommended to reduce the sustained damage from harsher soaps and detergents used at
work.

 Apply hand cream frequently after hand hygiene and before wearing gloves for a long duration.
A variety of hand creams can be effective. Favorites from our dermatologists include:
Neutrogena Norwegian Formula hand cream, CeraVe Therapeutic hand cream, Cetaphil Repair
Sensitive hand cream, Aquaphor Healing Ointment, and Eucerin cream. Cream or ointment-
based moisturizers are preferred to lotions.

Glove-related skin protection

 One layer of protective gloves is typically adequate for skin protection. An additional layer is
recommended if there is existing skin barrier damage or an underlying risk of gloves breaking.

 Gloves should not be worn for long periods of time. After removing gloves, perform hand
hygiene, then apply a hand cream.

 Thin cotton gloves can be worn underneath protective gloves if skin is highly irritated.

 In patients with hand eczema or contact dermatitis, steroid creams/ointments are

recommended. Over-the-counter options include hydrocortisone 1% cream or ointment.

Mask and goggles-related facial protection

 Prolonged use of masks/goggles can cause pressure injury with skin bruising, pressure-
associated hives/swelling, skin irritation, and skin dryness. Masks/goggles can also aggravate
existing skin diseases. Face shields are less likely to cause skin damage when compared to
goggles.

 If wearing a fitted mask, apply a moisturizer or gel to facial skin in order to reduce friction.

 Ensure goggles are not too tight to avoid pressure injury/bruising.

  Masks and goggles can aggravate acne, seborrheic dermatitis, and rosacea.  The Dermatology
department is available via e-visits for medical treatment, but gauze inside masks and facial
moisturizers may prevent flares by reducing friction.

Skin rashes and reactions to masks

 Apply moisturizers to face before using masks, but if stinging and significant rashes develop, you
may need to change your mask to another brand or type.

 Hives—itchy welts due to pressure from masks--can typically be treated with non-sedating over-
the-counter antihistamines, like Claritin, Zyrtec, or Allegra, or sedating anti-histamines, like
Benadryl

Nasal mucosa protection

 Remember that your nostrils can house viruses and bacteria

 Clean your nostrils after leaving isolation wards with cotton swab dipped in mild soap and water
for 3-5 rounds

Hair

 Short hair or tied-back hair is recommended when caring for COVID-positive patients so that it
can be completely covered by a surgical cap.

 Wash hair before the rest of your body when showering.

References:

1) Yan, Y., Chen, H., Chen, L., Cheng, B., et al. (2020), Consensus of Chinese experts on protection
of skin and mucous membrane barrier for healthcare workers fighting against coronavirus
disease 2019. Dermatologic Therapy. Accepted Author Manuscript.
2) Lan J, Song Z, Miao X, et al. Skin damage and the risk of infection among healthcare workers
managing coronavirus disease-2019 [published online ahead of print, 2020 Mar 11]. J Am Acad
Dermatol. 2020.